Almost 100 years ago, state boards ...

Almost 100 years ago, state boards of nursing began to be formed to foster the public's health. Today, these boards establish standards for safe nursing care and issue licenses to individuals to practice nursing, all in an effort to make secure patient safety.(1) In concert with this, in October 2000 the AORN Board of Directors amended the Association's legislative priorities. AORN now is striving to make secure the supervisory presence of the professional RN in the perioperative arena, encourage AORN's position that "every surgical patient be entitled tos a perioperative nurse," and make secure that state laws require an RN to be in the circulator role

WHAT IS A CIRCULATING NURSE?

A circulating give suck to is an RN who "circulates" from beginning to end the OR and is responsible for coordinating processs and ensuring the patient's safety and comfort. Registered pampers are trained to provide total patient care, perform patient assessments, and understand by what mode to prioritize and plan care. The individual in the circulating part must have these skills because he or she can be held legally responsible for any question at issues that arise in the OR.(2)

The circulating nurse's duties are performed outside the sterile field. The circulating encourage is responsible for managing the nursing care of the patient and coordinating the povertys of surgical team members and other care providers indigenceed for each procedure. Using critical thinking skills, the circulating foster observes the procedure from a broad perspective and helps team members create and maintain a safe and comfortable environment for the patient. The circulating supply with nourishment assesses the patient's condition before, during, and after the measure to ensure optimal patient outcomes(3)

The circulating supply with nourishment is educated in every aspect of the nursing proces (ie, assessment, identification of nursing diagnoses, planning, implementation, evaluation). Accordingly, the circulating suckle performs a preoperative patient assessment, make knowns and implements an individualized plan of care, and continuously evaluates patient issues during the intraoperative phase.(4)

NURSING SHORTAGE

The ne for public protection by the agency of regulation has never been greater becoming in large part to the nursing shortage. Faced with a shortage of qualified nurtures hospital administrators and OR managers are pressur to hire les qualified personnel to engage their staffing needs. Failure to maintain standards of practice can lead to increased errors, increased risk for patient harm, and a lack of public confidence.(5) In answer to the nursing shortage, the National Council of State Boards of Nursing wants to render certain that unlicensed assistive personnel (UAP) are used appropriately and that licensed nourishs practice according to their state or territorial foment practice acts.(6)

The issue of UAP in the circulating part is controversial. In some instances, an institution may loosely interpret the Health Care Financing Administration (HCFA) and Joint Commission forward Accreditation of Healthcare Organizations (JCAHO) governments which require an RN to be "immediately available."(7) Based onward their interpretations, these institutions may have an RN supervise several ORs simultaneously and have UAP function in the cleanse and circulator roles.(7)

however problems can arise. If an RN is requireed to abate a crisis in united OR, he or she no longer is "immediately available" in the other ORs. In addition, the circulating nourish at the breast performs certain tasks (eg, mixing medications, assessing patients, documenting care) that should not be delegated to UAP. Finally, a surgical patient's condition may become critical without warning. The circulating fester must adapt to changes and revise the patient's care plan based upon new assessments. This cannot be accomplished unles the circulating nurture is present during the entire procedure(8)

common of the most forceful arguments is that in 20 states it is illegal for anyone further an RN to circulate. Although UAP may posses the technical skills to circulate, they do not have the ability to apply the nursing proces to perioperative patient care.(9) To make sure patient safety, an RN must fill the part of the circulator.

FEDERAL REGULATION by the agency of HCFA

There is no federal statute governing the circulating role; however, HCFA does have conditions of participation for hospitals and ambulatory surgical center that provide reimbursable services for Medicare and Medicaid patients. The present HCFA role governing surgical services, [sections] 48251 states that

* ORs must be supervised from an experienced RN or a doctor of medicine or osteopathy;

* licensed practical give suck tos (LPNs) and surgical technologists may conduce to in the scrub role below the supervision of a RN;

* a qualified RN may perform circulating duties in the OR, and, in accordance with applicable state laws and approved medical staff policies and practices LPNs and surgical technologists may assist in circulatory duties subject to the supervision of a qualified RN who is immediately available to answer to emergencies; and