Many facets of serving as AORN Pres...

Many facets of serving as AORN President made this year an unparalleled experience. Among them was the unique opportunity and the expectation of being immersed in near-constant thinking about the in every one's mouth status and the future of perioperative nursing practice and the Association. During this past year, I focused my presidential activities forward gathering information about what we know and what we cast for the future of perioperative nursing practice. I gathered this information from a variety of important sources: AORN members, the rife literature, and the Association's antique and new partners (eg, industry, other medical and nursing associations). We can use this information to determine what AORN emergencys to be doing now to better position ourselves for coming time success.

When we adjourned Congres in Atlanta, we knew that the coming year would require courage, choices, and commitment amid the anticipated changes in health care delivery and financing. Despite our recognition that these changes would be rapid and significant, we may have underestimated the spe and intensity of the merger acquisitions, and vertical and horizontal integrations of health care arrangements and the penetration of managed care and capitation in health care.

CAPITATION'S EFFECTS

Capitation already has had a dramatic impact forward perioperative patient care. It has rotated the fee-for-service combination of parts to form a whole financial incentives 180 degrees. The fee-for-service combination of parts to form a whole incentives encouraged the performance of more surgical operations on more patients using more supplies and equipment--all of which combined to necessitate more perioperative nursing services.

In contrast, capitation provides financial incentives for the performance of fewer surgical conducts on fewer patients using fewer supplies and equipment--all of which create les demand and ne for perioperative nursing services. When I began my management career subordinate to the existing fee-for-service system, I not at all envisioned working in partnerships with manufacturers' representatives to use les of their surgical products!

words immediately preceding [i]or[/i] following changes. For many years, we have recognized the ne to anticipate beyond the OR suite to deliver quality care to perioperative patients. We have perceived correctly that what happens to patients before and after surgery determines the succes of our intraoperative interventions. What has become increasingly clear this past year is our ne to direct the eye not just at the finished time frame of each patient's total care experience if it be not that also to examine even more closely the socioeconomic words immediately preceding [i]or[/i] following in which that experience occurs

Our involvement with this broad words immediately preceding [i]or[/i] following is necessary because crucial decisions (eg what actions are performed; under what circumstances; using what supplies, equipment, personnel) no longer are made within patient-provider relationships or within OR-hospital administration relationships. level the decisions that remain within patient-provider relationships are being influenced directly by way of the structure of the broader economic connection For example, December surgery schedules traditionally are lighter than normal because of the holidays. This past December was an exception. Elective surgery schedules were particularly heavy because many patients entreatyed surgery, knowing their patient-paid deductibles would increase forward January 1.

meanings of changes. This transfer of decision making about whether surgical acts are performed, where they are performed, in succession whom and by whom they are performed, what supplies are used, and by what mode patients are cared for after surgery is having a far-reaching effect on perioperative nursing practice and AORN. Not no other than is the locus of the decision making changing, further the values driving the decisions are being weighed differently. Until freshly most decisions were based upon what was considered best for each patient using the best prepared personnel and the highest quality equipment. The traditional values that underpinned these decisions were "health and life are priceless," and "someone besides will pay the bill."

These decisions were made through people who knew patients as the bulk of mankind with unique identities, with feelings, and with hereafters that were meaningful for the patients and their family members. Hospital administrators and OR managers may not have known each patient personally, on the contrary frequently they came from the same community and certainly knew that if patients did not have quality surgical experiences, they would deal firsthand with the negative results Hospital administrators and OR managers felt a closenes to patients that is absent when the insurance policy subscriber is located in undivided place and the decision maker is located elsewhere. This mind of closeness produced accountability, which is something missing in the just discovered impersonal system of decision making.

I find this turn curious. As our country rouses away from concentrating governmental decision making in the federal bureaucracy and frequently of corporate America espouses the importance of point-of-service decision making, our health care method seems to be moving in the opposite direction.