Congress started on a high note for those of us who attended the Awards Dinner to see our own Jacklyn Takahashi Schuchardt receive the award for Outstanding Achievement in Perioperative Clinical Nursing Education from President Linda Groah. A gala affair, Jacklyn had her very own table two from the stage so we could see everything! It was a pleasure to listen to the accomplishments of our colleague and celebrate her achievements.
Other awards included the Perioperative Clinical Nursing Practice Award (Vicki Fox), Outstanding Achievement in Perioperative Nursing Management (Pauline Robitaille), Outstanding Achievement in Perioperative Nursing Research (Dr. Kathleen Gaberson), Chapter Research Award (AORN of Baltimore), Membership Awards (Region VIII, AORN of Los Angeles), Awards for Outstanding Achievement in Continuing Education, AORN Journal Writers Contest Awards, and the last Project Alpha Awards (there was no winner named for Region VIII).
Submitted by Donna Benotti
Opening Session was, as usual, exciting and exhilarating. The theme for Congress this year was "Rekindle the Passion." President Groah said she chose this as her theme because it's the reason most of us entered the profession. She stated, "Rekindling the passion will sustain us through this journey and keep us coming back to our fundamental purpose - providing quality patient care. This is the reason for our existence." There was so much energy in the audience that it felt like we were well on the way toward rekindling the passion.
The keynote speaker for the opening session was Leah L. Curtin, RN, MS, MA, DSc, FAAN. The title of her presentation was "Rekindle the Passion: Reclaim the Patient." She shared her experiences, feelings, and beliefs about reclaiming the soul of health care. She spoke about the current health care environment, the restructuring, and the down-sizing that have made many health care workers feel angry, depressed, and devalued. These emotions are contagious and cause people to focus on protecting themselves and blaming others. Dr. Curtin felt that "we, as nurses, must take responsibility for making things better right now. People's lives cannot wait and must not be compromised." The health care industry is now bought and sold on the open market, making greed and profit the norm. Dr. Curtin feels patients sense the change and, as a result, nurses need not reclaim patients because patients are rising up and reclaiming nurses.
Submitted by Evelyn Steen
The Pew Health Professions Commission and its Task Force have released three reports that have the potential to dramatically affect the delivery of health care and the practice arena. The reports identified predicted health care delivery changes, the probable impact on health care workers, recommendations for surviving the transformation and thriving in the emerging health care culture, and specific recommendations for health care work reform. Three experts, The Honorable Richard D. Lamm, BBA, LLb, CPA; Leah Curtin, RN, MS, MA, DSc, FAAN; and Tim Porter-O1Grady, RN, EdD, PhD, FAAN, offered their viewpoints in an incredibly lively debate on the possible impact on nursing practice. (AORN's response to the Pew Task Force on Health Care Workforce Regulation may be found in the February 1997 issue of the AORN Journal, pages 202-216).
Governor Lamm emphasized the financial aspects of the current system for health care delivery. He repeatedly said that the days of blank check medicine were over. He said if we continued on in the same manner, by 2029, the nation will be able to fund only four programs (Medicare, Medicaid, social security, and federal retirement). He believed the purchasers of health care needed to be in control, and he agreed with the Pew Commission that we have more hospitals than we can supply. Hospitals need to be "right-sized" and nurses1 roles will need to be expanded. He also wants RNs trained the "right way."
Leah Curtin believes there must be a recommitment to the patient. She believes there must be strong, clear regulation and that nurses need to be involved in the reform. She does not agree that increasing the number of consumers on the Board of Registered Nursing (BRN) will protect the public from practitioners. We must concentrate on service delivery and education. She disagrees with Governor Lamm that costs can be controlled by "right sizing." "We cannot control costs by regulating care to the least prepared, least paid, and least regulated." As we break professional practice into tasks or competencies, how and by whom shall our performance be evaluated and how will knowledge and critical thinking skills be determined?
Tim Porter-O�Grady looked at the ten recommendations published by the Task Force that are designed to promote discussion among state legislatures, professional boards, consumers, and the health care professional community concerning ways to improve the current regulatory system:
AORN has responded to the challenges of the Pew Commission by:
It is imperative that perioperative nurses become familiar with the Pew Commission1s recommended changes as they are already appearing in proposed legislation at the state level.
Submitted by Donna Benotti
As always, I came away with a renewed sense of purpose. Congress is like attending a tent revival meeting. It is easy to get carried away as you are surrounded by motivated, happy attendees who are wanting to learn, willing to listen, and anxious to share. I was very interested to learn how other chapters conducted business, raised funds, increased participation at meetings, and dealt with recruitment/retention. It was both reassuring and depressing to learn that our chapter is not unlike any other: decreasing membership, lack of participation, and the same complaints about people.
It was exciting to listen to the candidates speak about their passion for perioperative nursing, their perceptions of current issues, and their visions for the future of AORN. I was overwhelmed by the amount of work the Board had accomplished under Linda Groah1s leadership. In fact, there were six pages, double-sided and single-spaced, enumerating the accomplishments! I love learning new concepts so I am excited about the comprehensive model for perioperative nursing, the template for critical pathways, new perioperative outcome standards, age specific guidelines, and new perioperative nursing diagnoses from the Data Elements Committee that are on the horizon with the perioperative report card that will have indicators with which to define quality. The three project teams completed most of their work via telephone and faxes; most of the members work full time. It makes me proud to belong to AORN!
Submitted by Donna Benotti
My assignment was to write about the House of Delegates. Instead of a dry listing of all the topics, I'd like to give you the flavor and the ambiance of the House of Delegates.
This was my first Congress as a delegate because I never wanted to bypass the wonderful educational sessions in order to attend the mandatory forums (two or three), House of Delegates meetings (two), and two meetings to meet the candidates. In the end, it was worth it. Watching our national organization in action - conducting business - was impressive. I'm honored to have had the opportunity to participate.
The House of Delegates began Tuesday, April 8 with a roll call of all the states who reported on the number of delegates available for voting. It's like the Democratic and Republican National Conventions. Most states introduce themselves with descriptives just as they do in the National Conventions. My favorites were Wyoming and California (which were also short enough for my limited memory). Wyoming said they were the home of Yellowstone Park and also the home of the most favored UFO landing site, Devil's Tower (think of the movie, "Close Encounters of the Third Kind"). Wyoming had one delegate. California said they were the home of the last AORN Congress in this millennium (the 1999 Congress will be in San Francisco!). California had 136 delegates! The next largest contingent was Florida with 80 delegates. There was a total of 1391 delegates (1379 delegates cast ballots meaning 12 delegates didn't vote. Brenda Gregory Dawes, presidential candidate, lost the presidency by only 12 votes. Each individual ballot is essential!) A new member (Michelle Burke) of the National Nominating Committee impressed everyone. She won her seat with 1010 votes (the next highest vote for a candidate for the same committee was 566). Personally, I can easily envision Michelle Burke as National AORN President in the near future. She's strong, dynamic, and intelligent.
The House of Delegates opened Tuesday, April 8 with a bang. Linda Groah, National President, announced the 1998 Congress will not be open to all members of the surgical team. There had been heated discussion about this in the first Forum on Monday, April 7. This announcement was met with resounding applause.
There were many announcements and a review of Association business with presentations. The financial report was especially entertaining. Accolades should be showered upon Peter Derschang for discovering an innovative method for garnering attention for a dry subject. The report started with a narration of our revenue in the trillions with our deficit in the billions. The room exploded into laughter when Peter stopped himself and said, Oh no, that�s the Federal Congress in Washington, not us.
The best comment during this first session was shouted from the audience when Peter had problems with his laptop computer projecting images onto the screen. He was having a hardware or technical problem. An audience member shouted, You should have gotten a Mac! There was a smattering of applause for this comment - and your editor applauded the hardest and longest (yes, I�m a die-hard Macintosh lover).
Linda Groah gave her President�s Report. The highlight of the report was information concerning the Association of Surgical Technologists (AST). There have been meetings with AST concerning the need for common language and definitions. This need is clarified by the fact that AST defines pre-op assessment as getting the room ready. They do not consider pre-op assessment an assessment of the patient. They agree this assessment of the patient is outside their scope of practice. AORN and AST agree quality patient care is the foundation for all decisions. AORN is concerned about surgical technologists receiving minimal on-the-job training. Dialogue will continue in a meeting within the next six months.
AORN has reached out to many specialty nursing organizations. The American Society of Ophthalmic Registered Nurses (ASORN) accepted AORN�s offer to present an educational offering at this year�s Congress. AORN (and other nursing organizations) will meet with the American Medical Association (AMA) in May. AORN will meet with the American Society of Perianesthesia Nurses (ASPAN), the American Nurses Association (ANA), and other specialty nursing organizations June 1. AORN will meet with Materials Management and others on May 2 about common concerns and strategies.
Surgery Center - a Patient�s Place is a new web site for patients. This site has more than 150 links for patients to access information related to surgery. You can access this site through the AORN Online (http://www.aorn.org) home page or go directly to http://www.aorn.org/patient. (Spread the word to patients and physicians. An AORN member suggested telling your schedulers to inform the MDs� office staff about it when they call to book cases.)
Georgetown University in Washington, DC and AORN will develop a certificate program in OR management.
In 1995, JCAHO language stated the RN will be available to the patient. This was deleted in 1996 and the issue wasn�t addressed. In 1997, it said an RN will be provided to all patients undergoing surgery. The circulating RN assesses the patients� needs and if anyone else circulates, the RN is immediately available.
We have new rules. It is the same baseball game but the bases may be moved. The rules are changing so the criteria of values changes. For organizational success, we must learn to move our own bases. AORN is branching out and maintaining viability. Office space at Headquarters in Denver is 100% leased (AORN owns the Headquarters building). AORN manages other organizations (for a fee) and produces education programs for Industry.
The second House of Delegates met Thursday, April 10. It was announced the AORN Foundation received $1.2 million in fiscal year 1995-1996. Project team reports were given. I�m amazed at the vast amount of work that was accomplished by AORN. Many other reports were given and election results were announced.
Submitted by Mary Ritchie
A very important fact was discovered at this Congress - a sure-fire way to drive Donna Benotti wild. Donna suffers from severe intolerance to the lovely tune �It�s a Small World.� Donna was detained within the Small World ride at Disneyland years ago when it experienced a lengthy breakdown. Donna seems to have suffered lasting effects from the torture of the repetition of �It�s a small world after all....� Donna barely made it to Toon Town because we passed directly in front of the Small World ride with that lovely tune flooding the evening air. I know Donna is not alone in this repulsion. Anyone wanting to form a support group - call Donna.
I learned some interesting things in the class about perioperative data elements. These elements will be universal and measurable. These elements will justify and measure our work. The most exciting news of all is that my pet peeve will be cured/banished. AORN will adopt the definition for the start and incision times from the American Society of Anesthesia (ASA). We�ll have a universal meaning/definition not open to individual interpretation. It seems every RN and MD has his/her own definition of what constitutes the start and incision times.
The theme, �Rekindle the Passion,� was very true for me. Congress is truly a time of renewal. For those of you who have never attended Congress, I urge you to attend at least one to experience the sense of renewal. I encountered friends from former places of employment, met new people from near my hometown in Central New York State, and met Kathy Cooley, the former OR Director from my hometown hospital who created and maintains the home page for AORN Upstate New York. Kathy met me at the Net Cafe (a cafe with about six computers for members� use) and detailed (step-by-step) the process to create a free web site for the chapter. For the six months that I�ve had Internet access, I�ve said I was going to create a web page for our chapter (I�ve been stuck on �three to get ready� and having trouble reaching �four to go.�). Because of Kathy�s helpfulness and willingness to share information, we now have a web page.
This Congress has also influenced the appearance of this newsletter. The award winning newsletters were compiled into a binder at the AORN booth. I looked through all the winners and also looked at two other binders containing newsletters from other chapters. I wanted to sit down and thoroughly read everything but (in consideration for others) I could only look at the layouts. I was impressed. I loved the Lucinda Calligraphy font that I used for headlining articles but I had to admit there was a more professional appearance when the same font as the text was used for the headline. I also have a love of graphics and, seeing other newsletters, determined I overused graphics to such an extent that the newsletter didn't look professional compared to other chapters� newsletters. I got carried away with trying to make it reader friendly. Hopefully, it�ll still be reader friendly (with white space for readability) but with a more professional appearance. Please let me know what you think of the new look ([email protected]).
Submitted by Mary Ritchie
The former Director of Surgical Services at Summit Medical Center (when it was Merritt Peralta), Anne Uruburu, was the chairman of the task force on HIV. Anne presented the �AORN Revised Statement on the Patient and Health Care Workers with Human Immunodeficiency Virus (HIV) and Other Bloodborne Diseases.� The task force determined, in reviewing this statement, that it was appropriate to continue with it. The original statement as adopted by the Board in 1987 and ratified in 1988. It was revised in 1989, 1991, and 1997.
A study of the national membership in 1992 revealed that the knowledge of OR nurses wasn�t sufficient to allow them to provide safe care while maintaining safe practices. No more than two thirds of the surveyed nurses correctly answered questions about HIV and safe practices. Safe practices weren�t consistently employed.
A summary of this statement is that perioperative nurses (and all health care workers) shouldn�t discriminate against patients with bloodborne diseases (HIV, hepatitis) by refusing to participate in their care. Patients� privacy should be respected. Voluntary testing, with informed consent and counseling, for surgical patients and for all health care workers is supported. AORN supports funding for research, prevention, and care for patients with bloodborne diseases. If a patient is exposed to blood or hazardous body fluid of a health care worker, the patient should be offered voluntary, confidential testing with counseling. AORN also encourages health care facilities to support its workers who care for these infected patients to develop policies, programs, etc. to enable the workers the safety they deserve.
AORN believes health care workers should voluntarily know their HIV and Hepatitis B and C statuses. If the workers are seropositive, they should modify their participation in exposure-prone procedures except in extreme emergency situations. The workers should inform the appropriate people at their facilities and obtain counseling from an expert panel so they can review and modify their practice based on the best available scientific information.
AORN supports the recommendation from the Center for Disease Control (CDC) related to prevention of transmission of HIV and hepatitis to patients during exposure-prone invasive procedures.
AORN believes facilities should support seropositive health care workers endeavors to remain employed when their health status isn�t a risk to patients and doesn�t impair their performance. AORN supports the Americans with Disabilities Act of 1990 (protects seropositive health care workers from workplace discrimination).
AORN supports continued development and implementation of national standards for infection control practices and education of the public and health care workers concerning transmission of bloodborne diseases.
This statement is comprehensive and ethically and morally correct. It was ratified in the second House of Delegates on April 10.
Submitted by Mary Ritchie
The future of perioperative nursing is like health care itself - forever changing. AORN believes that only a registered professional nurse is qualified to provide an optimum level of care in the perioperative setting. AORN will continue to support this belief. To assist in providing quality patient care, AORN has developed statements of competency, recommended practices, and standards of practice for perioperative nursing. AORN president Linda Groah stated �If we are to assume a leadership role in the health care system of the future, we must step outside the boundaries of our roles and to move into the surgical patients� continuum of care.� In response to this challenge, the AORN Board of Directors convened a Think Tank to address the issue of the future of perioperative nursing practice. The result of this was the Comprehensive Model for Perioperative Nursing Practice. The model and role definitions provide definitions for nursing education, nursing research, and funding activities. There are three roles in this model.
Perioperative Clinician: a perioperative nurse responsible for the care of the patient during the preoperative, intraoperative, and postoperative periods, with emphasis on the intraoperative phase.
Interventional Care Coordinator: a certified perioperative nurse who is responsible for using clinical outcomes to provide leadership, clinical expertise, and functional direction to other members of the health care team.
Advanced Practice Practitioner: conducts comprehensive health assessments and functions in collegial relationships with other nurses, physicians, and other health care providers who influence the health environment.
Perioperative nursing is dynamic and must reflect the changing nature of societal needs. With this model, perioperative nurses can demonstrate competency to practice clinical expertise and knowledge in any of the three roles. This model provides directions for clinicians, educators, administrators, public policy makers, and funding entities regarding the contributions of perioperative nursing to the care of the surgical patient.
Submitted by Ellen Albano
The annual Operating Room Nursing Council of California (ORNCC) luncheon was held Monday, April 7, 1997 at the Marriott Hotel in Anaheim, California from 11:30am to 1:00pm. The lunch consisted of cold cuts, salads, soup, with cheesecake for dessert.
The program was �Open Water Rescue.� After the TWA crash off New York, Judy Dohle realized something of that nature could happen off the California coast. Dohle contacted the Public Affairs office of the Coast Guard and was able to secure a pilot and a flight surgeon from Northern California to speak to us. The pilot, Lt. Commander Edward Greiner, and the flight surgeon, Thomas Gross, MD, presented a very interesting program. They showed videos of some of their missions and of some of the equipment used to rescue people. They showed us how difficult it is to see one person floating in the ocean and how bad weather can be very dangerous for the crews of the helicopters. There was a brief history of the Coast Guard from its beginning in the 1700s to what its duties are today.
Submitted by Martha See
The Town Meeting, which used to be the third Forum, was held Wednesday, April 9th at 3:30pm in the arena of the Anaheim Convention Center. President Linda Groah presided over the first Town Meeting. The Board members were seated in groups around small tables at the edge of the stage which created a more informal setting than at the Forums.
First on the agenda was clarification of the Comprehensive Model for Perioperative Nursing, which was presented at the second Forum.
The issue of �short pays� was presented. This is where AORN members send in National dues but no local chapter dues. They do not consider themselves members of any local chapter. This is illegal. A nurse cannot belong to National without belonging to a local chapter if she/he lives within 50 miles of a chapter.
There was discussion about poor attendance at chapter meetings. There were suggestions from the audience such as re-engineering chapters and having mentors for the upcoming officers and having prizes donated to raffle at the meetings.
President Groah explained the Board had reversed its earlier decision about opening the 1998 Congress to all surgical team members. They felt there was too much energy concentrated on this one issue when there were more important issues the delegates needed to focus on.
Other topics discussed were: Project Alpha, headquarter�s method of assigning members to chapters based on their home addresses, members access to Board members via e-mail, and the recognition of sister cities.
Submitted by Martha See
AORN hosted its annual OR Nurse Week poster contest at Congress. The OR Nurse Week posters were on display in the perioperative bookstore and reflected the theme of that campaign, �The Language May Be Different, But The Perioperative Heart Beats The Same.� First place went to the Veterans Administration Medical Center in Gainesville, FL and was entitled, �Making A World of Difference.� It displayed a number of holographic photographs of medical scenes from the United States, Puerto Rico, Russia, Poland, and Cuba. Perioperative nurse qualities and roles were spotlighted. The roles included planning, teaching, assisting, documentation, advocacy, implementation, accountability, and collaboration, with communication being central to all.
Second place was awarded to the AORN Chicago Chapter 1401. The poster celebrated the rich ethnic diversity of the �City That Works.� Its goal was to blend professional and cultural strengths into the unified spectrum that is AORN and perioperative nursing. Activities of their week included hands-on opportunities for the public to perform laparoscopic surgery, use of a harmonic scalpel, and handling joint replacement instruments and implants.
Finally, third place went to AORN of Kansas City. Their week was highlighted by a parade of OR nurses who carried a banner that read, �You Need and Deserve a Perioperative Nurse - OR Nurses of Greater Kansas City.�
Posters were judged on the use of the OR Nurse Week theme, creativity, and general artistic appeal.
Research in perioperative nursing practice is crucial to the development of new practices and the validation of existing practices. Each year at Congress, posters are on display that detail recent research. The Research Committee recognized five posters to receive awards this year.
The first poster was entitled �Reprocessing of Disposable Products: Current Practice in the Heartland.� It was contributed by AORN of Greater Kansas City Research Committee. Their study involved a survey to assess the reuse practice of single-use, disposable medical devices at local hospitals and identification of problems involved with reprocessing.
Another poster looked at the �Effect of Methods of Preoperative Education on Patient Satisfaction, Postoperative Recovery, and Return to Functional Status.� It was submitted by Madonna Pool, RN, BSN and Sandra Lookinland, RN, PhD. Their study evaluated the effect of preadmission, structured education in the experimental group versus post admission, unstructured education in the control group. Patient satisfaction, postoperative recovery, and return to functional status were measured.
Sean Wheelock, RN, MS, FNP and Sandra Lookinland, RN, PhD contributed �Effect of Surgical Scrub Time on Subsequent Bacterial Growth.� This poster demonstrated that a two minute scrub was clinically as effective as a three minute scrub.
The departments of Nursing and Cardiovascular Surgery, The Toronto Hospital, Toronto, Ontario, Canada looked at �Minimally Invasive Cardiac Surgery (MICS) Prolongs Operating Time but Reduces Overall Hospital Length of Stay.� The potential for improved cost-effectiveness with MICS over CABG (coronary artery bypass grafting) was borne out by this study.
Lastly, the �Spiritual Needs of Mormon Women in the Health Care Setting� were examined by Carolyn A. Ramsey, RN, MSN, CNOR and Joan Corbin-Ervin, RN, MSN. They utilized a questionnaire and interviews to determine that Mormon women prefer chaplains to nurses when receiving spiritual care in the health care setting.
Review of the research posters at AORN Congress allows nurses to enrich their practices. Sharing of information among professionals is a necessary ingredient for excellence in practice.
There were 7079 exhibitors registered for the 44th annual AORN Congress. They brought with them the most up-to-date technology. It was fun going around looking at the different booths and being able to touch and handle all the high-tech equipment. There was no doubt if you were looking for that just-right piece of equipment for your OR, that this was the place to find it. Many of the exhibitors offered continuing education programs in the exhibit area and we were able to pick up some extra contact hours. Thanks to our friends in industry.
Submitted by Donna Rodgers
The closing session always puts the final touch on the week and brings it to a close. This is where the changing of the guard takes place. The newly elected officials were introduced to the members. President Linda Groah handed over the gavel to the new president, Jeannie Botsford. Our new president, Jeannie Botsford said, �We must identify what our futures will be and then proactively soar into the future.� The theme our new president chose to carry us into the next year was �Soaring Into the Future.� Her symbol for this theme was a hot air balloon.
�The Passion and the Promise: Creating Our Own Future� was the title of the keynote address for the closing session. Tim Porter-O�Grady RN, EdD, CNAA, FAAN was the keynote speaker. This is the third appearance for this dynamic speaker. He is on the graduate faculty of Emory University in Atlanta.
There are major transformations in the health care industry - not only local but national and global as well. We are watching the end of health care as we know it. There is a different set of variables and the new must emerge. The winds are blowing and a new way of advancing is coming.
We are in the age of technology. Computers are changing what we do and what we are. We must create new boundaries; the old ones have no meaning. There are some tough times ahead because we do not know where we are going. We need to progress with new ideas and invite other health care professionals to the table. It is up to us to decide where we are going and not let those who do not know tell us what to do.
The work setting is different, culture calls for a change, and you must be able to move. We must be mobile, fluid, and flexible. We are at adolescence and are moving into adulthood. We are accountable as providers of the future.
Submitted by Lila McAlhany
The Association of Operating Room Nurses held their 44th annual Congress April 6-11, 1997 in Anaheim, CA.
Our chapter sent six delegates and one alternate to Congress this year. The delegation consisted of: Evelyn Steen (chairman), Donna Benotti, Mary Ritchie, Ellen Albano, Martha See, Lila McAlhany, and Donna Rodgers (alternate). Your delegates took their responsibilities very seriously. They attended all the Forums and the House of Delegates meetings to stay informed about all the issues so they could make informed decisions that would benefit both our chapter and the organization as a whole.
Each delegate was given two to three candidates to interview on Sunday to discover their views on the issues. The interviews also provided insight into the candidates� qualifications for their intended offices. We met on Wednesday to share our information and to discuss the attributes and weaknesses of the candidates. The delegates went to the polls on Thursday and voted for the candidates they felt would best benefit the organization.
1997-1998 Officers and Board of Directors for National AORN
(* = newly elected)
Submitted by Evelyn Steen
