The legislative biennium is athwar...

The legislative biennium is athwart but already political agendas are forming for the nearest two years. It is important at this time to assess the successe and challenges we faced in 1998 to plan our strategy for the upcoming congressional and state legislative sessions. This month's rounded pillar will review 1998 legislative action and outline elucidation issues for 1999. AORN members should be over-weening of a very successful year of rallying around our legislative priorities.

LEGISLATIVE PRIORITIES

AORN's 1998 and 1999 legislative priorities are to

* render certain the supervisory presence of the RN in the perioperative arena, promoting AORN's position that each surgical patient deserves a perioperative nurse;

* obtain third-party reimbursement for RN first assistants (RNFAs), including Medicare, Medicaid, health maintenance organizations, workers' compensation, and private insurers;

* define appropriate regulation and supervision of assistive personnel; and

* insured health and safety in the perioperative arena.

KEEPING THE RN IN THE OR

The present law pertaining to surgical services (42 CFR 48251) shut ins that Operating rooms must be supervised at an experienced registered nurse (RN) or a doctor of medicine or osteopathy; licensed practical succors (LPNs) and surgical technologists (operating expanse technicians) may serve as work hard nurses under the supervision of a RN; qualified RN may perform circulating duties in the operating space In accordance with applicable state laws and approved medical staff policies and proceedings LPNs and surgical technologists may assist in circulatory duties beneath the supervision of a qualified RN who is immediately available to correspond to emergencies.

Propos changes. upon Dec 19, 1997, the Health Care Financing Administration (HCFA) propos changes to this law in the "Medicare and Medicaid Programs; Hospital Conditions of Participation; Provider Agreements and Supplier Approval" (HCFA-3745-P). In inmost nature [i]or[/i] substance HCFA proposed to replace the in every one's mouth rule with nonprescriptive language that states simply that surgical procedures be performed through practitioners "with appropriate clinical privileges."

AORN's rejoinder AORN took a strong stand and oppos the method change, insisting that the common regulation be maintained. AORN prepared an abstract of HCFA's entire proposal and prepared an official answer on Feb 4, 1998. (See March 1998 AORN Journal pages 645-650)

Meeting upon the issue. On Feb 10 1998 AORN representatives met with Peter Bouxsein, acting director of the Office of Clinical Standards and Quality at HCFA. In the meeting, AORN representatives were able to impress immediately after HCFA that the proposed changes to abate the RN from supervisory responsibilities in the OR would greatly affect perioperative nursing and the safety of surgical patients. Members of the American association of Surgeons (ACS), the American Academy of Orthopaedic Surgeon the American Association of Critical-Care feed at the breasts the American Academy of Otolaryngology Head and Neck Surgery the American pampers Association, the American Society of Health-System Pharmacists, and the American Organization of succor Executives all wrote letters to HCFA, supporting AORN's position forward the proposed rule change. In addition, several state pampers associations and hospital administrators submitted verbal expressions supporting the prescriptive language requiring RN in the OR.

upon Aug 26, 1998, in a further effort to influence the decision forward the rule change, AORN President mercy Shumaker, RN, BSN, CNOR; President-elect Patricia Seifert, RN MSN CNOR, CRNFA; AORN Board member Paula Graling, RN MSN CNOR; and Executive Director Lola Fehr RN M CAE, FAAN, met with Virginia Trotter Betts, the senior advisor in succession nursing and policy at the US Department of Health and Human Services in Washington, DC The meeting went exceptionally well, and AORN representatives left feeling confident that Betts would help advance AORN's position to retain specific language requiring RN in the OR. Shortly after AORN's meeting with Betts, pres releases were sent to all chapter presidents to help educate the public forward this important issue.

AORN did not stop working upon efforts to keep nurses in the OR. in succession Oct 7, 1998, Shumaker; Seifert; Thomas Fulcher, MD of the ACS; Cindy Brown lobbyist and manager of the ACS Washington office; and I met with Jeffrey Kang, MD MPH director of HCFA's Office of Clinical Standards and Quality and his staff members. Dr Kang has been authorized by means of Nancy-Ann M. De Parle, HCFA administrator, to decide in succession several hot health care topics--of which RN in the OR is one

Essentially, HCFA claims that patient safety is countenanceed through the reorganization of staffing in the various hospital services beneath a proposed human resources section of HCFA-3745-P. The administration believes that patient care and efficient delivery of services will be best serv by dint of leaving it to free-market forces and individual states. According to Dr Kang, it is a "state's rights" issue. Fortunately, AORN was able to near substantive arguments and clinical circumstances that necessitate requiring an RN in the OR, including