AORN Alameda County, CA
Legislative Committee Reports


summit

CALIFORNIA SUMMIT
October and December 2002 Newsletters


California will need 31,000 more registered nurses (RNs) by 2006 than will be available. This is a public health crisis. This data is based on projected imbalances in demand for and supply of RNs. Demand for RNs is evidenced by anticipated population growth; California's proposed nurse-staffing ratios; and current RN vacancy rates in hospitals and other employment settings; as well as intended increases in employment of RNs. California ranks second only to Nevada in the lowest proportion of working RNs per 100,000 population in the nation. Yet, California has a higher-than-average proportion of RNs with active licenses working in nursing. In October 1999, more than 900 nurses from across California came together to discuss strategies for addressing the nurse shortage. Since that time, employers and institutions of higher learning have developed regional partnerships to address the shortage. Strategies to increase capacity within California's nursing programs are being developed. In January 2002, Governor Davis committed $60 million over a three-year period to help address the nurse shortage. It is time for the nursing community to come together to discuss successes, share strategies and develop new insights into what is being termed the worst nurse shortage in the history of our profession. Join us to learn what national nursing organizations are doing to address the shortage; what the federal government is doing to support nursing and nursing education via the Nurse Reinvestment Act; what activities our governor has proposed; and what our local leaders and peers are doing to address the impending crisis. California's nursing professionals will discuss strategies that have been implemented or can be implemented to address education, diversity and work environment barriers that prevent recruitment into the profession, and retention of the current nursing workforce.”


Meet Our Needs!

“California Strategic Planning Committee for Nursing (CSPCN) members represent the leadership of more than 35 nursing and health care organizations and state agencies. Its purpose was to strategically plan for an appropriate nursing workforce to meet the needs of California's people. This final phase of work has been funded in part by The Robert Wood Johnson Foundation's national program, Colleagues in Caring: Regional Collaboratives for Nursing Work Force Development. Other financial supporters of this work include Kaiser Permanente, Office of Statewide Health Planning and Development, Board of Registered Nursing (BRN), University of California at Irvine, American Nurses Association/California and Association of California Nurse Leaders. Nurse leaders from across the state have invested thousands of volunteer hours to accomplish the work of CSPCN. To those who contributed to the success of this project, we say thank you.”

The above quotes are from the brochure for the program “California Addresses the Nurse Shortage: Collaborative Partnerships” held at the Sacramento Convention Center September 13, 2002. This conference was attended and written about by Pam Reuling. Part I appeared in the October 2002 newsletter. Part II appeared in the December 2002 newsletter. The article in its entirety can be found here:

This was an absolutely fantastic program that Toots (Toots Sweeney from SF/Marin chapter) and I thoroughly enjoyed. It kept our attention the entire day (i.e. we didn’t nod off once and you’re talking about 2 retirees who haven’t been up at 5 AM in a long time, not to mention the 2 hour drive to Sacramento!!)

Nursing Today: Opportunities for Tomorrow

The keynote presentation “Nursing Today: Opportunities for Tomorrow” was given by our own ‘California Girl’, Mary Foley, Immediate Past President of American Nurses Association. She talked about the staffing shortage vs. the nursing shortage. She defined the staffing shortage as: insufficient number, mix, and/or experience level of RNs and ancillary staff to safely care for the individual and aggregate needs of a specific patient population over a specified period of time. Potential causes for staffing shortages are: restructuring and reengineering, lack of entry level positions for new graduates, increased patient acuity, shorter lengths of stay, rising census, change in skill mix with decreased use of LPN/LVNs and increased use UAPs, increased demand for nurses in multiple settings, changes in reimbursement, and professional dissatisfaction. The nursing shortage was defined as: the demand and need for RN services is greater than the supply of RNs who are qualified, available and willing to do the work. Potential causes for the nursing shortage are: other professional career opportunities for men, and now, women; public perception of nursing wages, working conditions, and career growth; aging nursing workforce; faculty shortages; aging US population/longevity; and increased use of technology. Retention is at the intersection of the two shortages as recruitment alone will not assure an adequate nursing supply. Nurses must be satisfied to be retained and this means improving the overall work/care environment, retaining the aging nurse, improving the image, and therefore, enhancing the potential to recruit. A call went to the nursing profession for collaboration in developing a comprehensive plan and a unified message around a national/global issue for the purpose of ensuring safe, high quality care for all health care consumers and a sufficient supply of RNs to deliver that care. Twenty professional nursing organizations formed a steering committee to give input and support. They determined the desired future state of nursing is that it be the pivotal health care profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care. Individuals should choose nursing as a career and remain in the profession because of the opportunities for personal and professional growth, supportive work environment and compensation commensurate with roles and responsibilities. All nursing domains must work together to make this happen, i.e. work environment, economic value, education, legislation/regulation/policy, delivery systems/nursing practice models, diversity, recruitment/retention, professional/nursing culture, PR/ communication and leadership/planning. What does tomorrow hold? Warnings from the headlines are: rising health care costs, loosened managed care controls, health premium increases and rising number of uninsured — all factors that lead to the staffing cuts of the 1990s.

Show Me the Money !!! Understanding Federal Funding for Nursing

“Show Me the Money !!! Understanding Federal Funding for Nursing” was the next session presented by another ‘California Girl’, Catherine Dodd, District Chief of Staff and Health Advisor for US Rep Nancy Pelosi. She began with a history lesson about nursing shortages and quipped “what we need is another war” as sad but true, wartime has bolstered nursing with both increased numbers and visible leadership. At present, Congress is trying to increase the budget of Health Resources and Services Administration (HRSA) which has been decreased by President Bush so he can increase funding to NIH. HRSA is under the US Dept of Health and Human Services and deals with the Bureau of Health Professions. The Nurse Reinvestment Act (sponsored by another ‘California Girl’, Lois Capps, Congress Rep and a nurse from S CA) was signed into law 8/1/02. But, it has only received authorization and NOT appropriation. Another lesson like the difference between nursing and staffing shortages: authorizing establishes a need and directs spending to occur; however, appropriating determines how much will be spent. So our job isn’t over with getting the bill passed and signed. Now we need to have appropriations “Show us the money!!” Letters to our Senators and Representatives are needed to encourage adequate funding.

The California Nursing WorkForce: Just the Facts

“The California Nursing WorkForce: Just the Facts!” was presented by Karen Sechrist, Principle Investigator, CSPCN. From its inception CSPCN’s goal has been the development of reliable data for public policy and resource allocation decisions to meet California’s need for nurses. Their objectives are based on supply/demand: develop and maintain a dynamic forecasting model to predict the nursing work force California’s people will need for their health care, develop a strategic plan to ensure the supply of nurses meets the demand, and implement the strategic plan. The Federal work force projects a demand of a little over 1 million additional RN’s by 2010 and California’s projection is about 110,000 or 1/10th of that. Demographics in CA show a population increase of 52% by 2025 with * of this increase from international immigration. Also CA’s population is aging and those over 65 account for 48% of hospital visits and 23% of ambulatory visits. Legislative action related to nurse/patient ratios and mandatory overtime limits/elimination while good for nurses and patients also puts extra burden on supply/demand. Regarding the proportion of RNs to population CA has 544 RNs/100,000 population. The national average is 782 RNs/100,000. CA is 2nd lowest in the nation and 1st is Nevada with 520 RNs/100,000. Implications of the selected data are: the nursing shortage threatens access to health care, quality of care and patient safety; the nursing work force continues to age; nursing school enrollments nationally and in CA are not increasing at the same rate as is demand; and increasing numbers of BSN and MSN prepared nurses are demanded by employers. The conclusion is that the overall supply of nurses cannot adjust to demand under current conditions, i.e. the proportion of RNs to the CA population is among the lowest in the nation, about 82% of RNs with active licenses in CA are working and other states and countries already supply more than 50 % of CA RNs. Recommendations are that CA fund increased enrollments in existing and new CA pre-licensure nursing programs including scholarship and loan programs and that CA encourage Education-Industry partnership to support new nursing education slots and to facilitate associate degree graduate completion of baccalaureate and higher degrees. The next step is to seek legislative support for individual and regional initiatives.

Say What? What California Nurses Say About Working in CA

“Say What? What California Nurses Say About Working in CA” was a joint effort by Deloras Jones, NurseWeek/AONE National Survey of RNs and Carol Bradley, Regional VP and Editor of CA Edition of NurseWeek. These 2 nurses did an objective assessment of nurses career intentions and their view of the work environment to educate and inform policy makers and industry leaders on constructive actions towards retaining the current and future RN workforce. This was a 4 month data collection process from a randomized national sample of 7600 RNs (10% from CA). The data included demographics: general background info, work patterns and settings, education and unionization; nurses views on: the healthcare delivery system (78% felt fundamental changes were needed); the nursing shortage (almost unanimous agreement there is one! , i.e. 95%); the shortage impact on quality care and practice (most felt was negative); causes of and solutions for the nursing shortage; work risks: safety/environment; overtime: voluntary or mandatory?; influence and impact of unionization; quality of current work setting; and career intentions (over 50% planning to stay in current position for 3 years and 75% of those leaving current position will stay within nursing). Of RNs planning to leave about 50% indicated “very likely” strategies for retention as: higher salaries and benefits, better staffing, more respect from management, and opportunities for professional development. Non-working nurses listed from most to least important possible strategies for returning to nursing as: less stressful work environment, higher wages, better hours and more professionally challenging position. Interestingly, 80-90% of the nurses surveyed were satisfied with their current job and with being a nurse. As far as promotion of the profession, over 60% would advise young students to pursue nursing (this % was higher with younger and higher educated nurses). In summary, this study identified what factors influenced nurses’ views of their career, job, and workplace and identified steps nursing leaders could take to enhance positives and remove barriers to the full professionalization of nursing practice.

Gold in California: CA’s Nursing WorkForce Initiative

“Gold in California: CA’s Nursing WorkForce Initiative” was presented by Ruth Ann Terry, BRN. This initiative is funded primarily from Workforce Investment Act funds and its goal is to produce more licensed nurses and improve nurse retention. The 3 foci of this initiative are: $24 million over 3 years for regional training collaboration projects; $3 million for onsite health care facility approaches (OnSite Career Ladder Projects{OCL}) to upgrade training opportunities to produce licensed nurses; and $1 million to encourage workplace reforms projects designed to improve nurse retention. These projects have brought together people who really hadn’t worked together before and the money is there even for “soft expenses”, i.e. child care, transportation, uniforms, etc. There is also a real emphasis on education reform to explore strategies to standardize pre-nursing prerequisites and nursing education curriculum. AB 2314 (Helen Thomson) would encourage Community Colleges and the CSU system to standardize prerequisites and corequisites statewide plus have the 2 systems enter into articulation agreements to reduce matriculation barriers. BRN is also working on an Online Application to streamline the nurse licensing process.

Smooth Road Ahead: Education Mobility Made Easy

“Smooth Road Ahead: Education Mobility Made Easy” Six speakers presented 4 pilot projects that are presently occurring in CA. Robyn Nelson, CSU Sac and Diane Welch, Sac City College reported on their educational collaboration that leads to a BS degree in nursing. This is a 3 step model: 1 program, 2 campuses and 3 outcomes. The 3 outcomes are increased BS prepared nurses, increased professional role socialization and effective use of strengths existing in 2 nursing programs. Logistics include concurrent enrollment at both SCC and CSUS as courses are taken at both campuses, joint appointment for faculty and tuition assistance. Also CSUS courses can be taken “on line” or via TV. Combining the 2 schools makes education more cost effective and the graduates have the best of both worlds. Dianne Moore, Fresno City College, is collaborating with area hospitals to sponsor their employees at FCC. The hospitals all have 5 guaranteed ‘slots’, they choose their own candidates, class schedule of 3 days allows the employee to still work while in school, and the hospitals have found this sponsorship is cheaper than hiring a travel nurse. Outreach and collaborative partnerships have also been developed with CSU Fresno, high school ROPs, and community Girl and Boy Scout troops. Sharon Hall, Glendale Community College and Judy Papenhausen, CSU LA developed an articulation model for the LA area to provide seamless transition for students transferring prerequisite and 1st year basic nursing courses to CSU for completion of the BSN. Partners besides Glendale are: LA Trade Technical College, Mt. San Antonio College and Rio Honda Community College. Students enter the community college in a special collaborative track designed for transfer to CSULA. This is cost effective and targets students who would have sought a BSN but for whom the traditional path is not possible. Arlene Sargent of Samuel Merritt College has developed entry level graduate programs in nursing for non-nursing graduates. These graduates must have a BS in another field and must have the basic science prerequisites. So far the students admitted have been older with a higher % of males, highly motivated, excel in class, have high GPAs and high academic expectations, are eager to gain clinical experiences and bring a wide array of backgrounds. After 15 months they can take the NCLEX and so far have had a high pass rate. They can then work as nurses and go part time through the rest of the Master’s program if they so choose. Surveys show that employers are very pleased with these graduates and are actively recruiting them.

All Stars: Best Practices from Industry

“All Stars: Best Practices from Industry” Linda Burns Bolton, VP and Chief Nursing Officer, Cedars-Sinai Medical Center, discussed Magnet Hospitals best practices. The Institute for Professional Nursing created a strategic plan to achieve and maintain elements of magnetism. In Magnet hospitals the staff nurses are seen as experts with good answers to problems and therefore consultants are not always needed. The “new patient focused care’ design team develops meaningful goals within the interdisciplinary members which gives them the opportunity to utilize knowledge and skills. RN-MD collaborative practice adopted a code of conduct which includes an annual survey of staff nurses on their satisfaction with medical staff and allows for sanctions vs MDs. There are multiple opportunities to create satisfying environments, i.e. engage staff, listen and be prepared to keep quiet, embrace half baked ideas, and commit to professional nursing and career development. Judy Martin-Holland, Co-Chair of CSPCNs Diversity Work Group, In CA’s rich cultural diversity there are ethnic/racial disparities between the population and the nursing work force. These need to be considered as strategic planning addresses population needs and nursing supply. While new admissions to nursing programs more closely parallel the diversity the # of graduates do not which points to retention difficulties. Recruitment strategies, retention and barriers to success are being explored. Culturally sensitive care honors racial, cultural, ethnic, religious and socioeconomic diversity and the relationship between this care and the diversity of the work force needs to be assessed. Culturally sensitive care comes from acceptance, acknowledgment and learning from those who can bridge the gap. Interaction with a diversity of colleagues allows us to challenge or validate our beliefs and bridge gaps. “The Nursing Shortage: Can Technology Help?”, a June, 2002 publication prepared by the First Consulting Group was discussed by Erica Drazen, VP, 1st Consulting Group. To address the nursing shortage a combination of increased nursing supply and decreased demand on nurse’s time is needed. It is felt that technology can help decrease this demand on nurses’ time and improve job satisfaction in the areas of: staff scheduling, communication (wireless phones, online patient education and documentation systems), and care delivery (smart IV pumps, documentation, physician ordering and medication administration).

All Stars: Successful Education and Industry Collaboratives from Across the State

“All Stars: Successful Education and Industry Collaboratives from Across the State” Carol Bradley talked a little more about the Nursing Workforce Initiative which has as its key objectives: cultivation of hospital/academic partnerships, increasing enrollments of generic students, providing a “matchmaker” for relationships between schools and hospitals, and identifying and mitigating other barriers to enrollment expansion. Pilar De La Cruz-Reyes, Director of Education, Community Medical Centers, Fresno, presented the Paradigm Program, developed by the Fresno Hospitals with Fresno Community College which was discussed prior from FCC’s perspective. Brainstorming was done with FCC, a program was developed to meet both hospital and education needs, and other area hospitals wanted to join so it expanded to 5 hospitals. So far the success rate has been good with passing course work and the NCLEX. The program has expanded to 35 students (at the beginning it was 5 slots/5 hospitals) and everyone feels it is a win/win/win situation! It has also become a great recruitment tool. Mary Middleton, Director, Patient Services, UCSD Medical Center gave a progress report on Nurses Now, a partnership with SDSU that expanded enrollment of nursing students from 50 to 90. Ten hospitals and/or health related organizations are now partners who each fund additional faculty resources for 20 students. By May, 2005, it is projected there will be an additional 180 nurses due to the SDSU Nurses Now program.

It’s a New Day! Your Future!

“It’s a New Day! Your Future!” Sarah Keating, Chair, CSPCN, concluded the program with a history of CSPCN from its inception in 1993 until its finale in 2002. Today we have both federal and state funding and innovative programs in education and practice plus collaboration. The future includes recruitment and diversity and more public awareness like the Johnson and Johnson campaign. We as nurse can help with recruitment, practice and career planning. We should learn from history’s lessons and create a new world for nursing and the people it serves!

The Association of CA Nurse Leaders (ACNL) coordinated the Summit and can be reached by phone at (916) 552-7529 or on their web site ACNL.org. I am hoping they will have info from this Summit on their site.

By Pam Reuling


orncc

Operating Room Nursing Council of California (ORNCC) Meeting in Long Beach September 14, 2002
October 2002 Newsletter


Pat Patterson from “OR Manager” newsletter, “the monthly publication for OR decision makers,” spoke about the “Managing Today’s OR Suite” conference held at the Long Beach Convention Center September 11-13. ORNCC co-sponsored the conference with OR Manager. The conference was rated excellent or very good by 91% of the attendees. The Manchester Grand Hyatt, One Market Place, San Diego, CA 92101, will be the location for the next “Managing Today’s OR Suite” September 17-19, 2003. This will be a “one location” meeting. Meetings have always been held on the East Coast (Baltimore, MD October 16-18, 2002) and on the West Coast (Long Beach September 11-13, 2002). This is proving to be too difficult and expensive for the vendors. ORNCC will also co-sponsor the San Diego meeting. (See www.ormanager.com for more information.)

National AORN

Sherron C Kurtz, RN, MSA, CNOR, CNAA - GA is one of nine candidates running for National AORN Board of Directors.  William J. Duffy, RN, BSN, MJ, CNOR - IL is one of two candidates running for President-Elect of National AORN. Both Sherron and Bill attended our ORNCC meeting.  Marilyn L. Sanderson, RN,BSN,CNOR - CA is one of five candidates for National AORN Nominating Committee. Marilyn was in charge of the 2002 Anaheim Congress volunteers. 
(See www.aorn.org/about/2003slate.htm for more information.)


Treasurer’s Report

The Treasurer’s report was ORNCC took in $12,906.71 and spent $10,735.45 for the year. There is $6,297.64 in the bank. ORNCC’s total assets are $14,000. These figures don’t include expenses from the September 14, 2002 lunch. For those of you who are members of ORNCC and receive minutes, you’ll see “October meeting” listed. The October meeting is actually the September 14 meeting. Chapter membership is very low. I was happy to hear Alameda County has paid our dues! 


$1000 Scholarships

Scholarships are available through ORNCC. For detailed information, see www.orncc.org/Schlships.htm. You may apply for a scholarship if you’re:
* An RN attending a formal Perioperative Training Program that is either college or hospital based.
* An RN who is a member of the ORNCC and is attending a recognized RNFA program.
* An RN who is a member of the ORNCC who is attending a BSN or advanced degree program.
* A health care facility with an identified need for financial assistance in sending staff to a perioperative or RNFA program.
A mimimun of $1,000 will be granted and additional funds can be awarded. Applications are due November 1, 2002. Contact Vicki Contryman, ORNCC Vice Chair/Treasurer, 20315 Trails End Road, Walnut, CA 91789-1838. Telephone 909-598-6460. E-mail bcontryman@earthlink.net. If you’d like to become a member of ORNCC to apply for a scholarship, visit www.orncc.org or see our Legislative Committee chairman, Jackie Cummings (jackiecummings@cs.com). Membership is $35.

ORNCC Web Site

Suzanne Ward, web creator/manager for ORNCC, says the web site (www.orncc.org) now works with Netscape. It’s only worked with Microsoft Interenet Explorer in the past. I still can’t access the site with my Netscape - but others are able to.

Presentation 

Bill Duffy presented “Through the Malpractice Looking Glass: Reflections on Perioperative Nursing Actions.” AORN of Orange County awarded us one contact hour for this excellent program.

McDonalds and Hot, Tasteless Coffee

Bill started the presentation by saying our legal system is not a system of justice; it’s a system of law. Don’t look for fairness. And then he demonstrated that concept through scenarios. One was the famous McDonals’s hot coffee lawsuit where the woman burned her legs when her hot coffee spilled (after she placed it between her legs!). McDonald’s admitted their coffee was super heated so people sip and swallow and avoid actually tasting the coffee. McDonald’s (and all the other fast food places) save millions of dollars on coffee grounds with that method. (Bill mentioned that’s why Starbuck’s is so successful - because they make flavorful coffee!) McDonald’s was truthful about the common - and unknown - super hot coffee ploy and the jury didn’t react favorably to McDonald’s for that information. I’m sure many of us feel the woman was at fault for her lack of judgment in the placement of a hot coffee cup between her legs but our law system isn’t fair. 

Cars, Trains, Phones, and Bad Luck

Another example where a large company paid for someone else’s mistake is the case of a telephone booth in the wrong place with a man in it at the wrong time. A man had a car with failing brakes. He knew something was wrong with his car and visited a garage where he was told to wait and the brakes would be repaired while he waited. He declined to wait. As he drove down a mile long hill, his brakes failed (you had to know that was coming!). There were railroad tracks at the bottom of the hill and a train was passing by as the man in his car came flying off the hill and bcame airborne as he hit the edge of the tracks or something in the road and flew over the train (which just happened to have a flatbed car at that area for the brakeless car to sail over and through!). Unforunately, there was a phone booth with a man in it on the other side of the tracks. The car hit the phone booth and the man. The man in the phone booth sued due to the loss of both legs. Who paid the damages? The uninsured driver of the brakeless car? The train for having a flatbed car at the exact point that allowed the car to reach the other side? The mechanic for allowing the driver to leave with bad brakes? No! The phone company paid damages to the double amputee for having a phone booth in a dangerous spot! Fair? No! But the jury wanted to compensate the man for his terrible injuries and loss of both legs. The phone company paid. Deep and large pockets always seem to pay. 

Nursing Advice

Policies are standards of care. You must follow your written policies. Procedures are guidelines only. It’s a good idea to state in writing that your procedures are only guidelines. Do not have policies on the books that people don’t follow.

Definitions

Negligence is where a patient has to suffer a physical injury. Battery is unauthorized touching. An example of battery is when a patient hasn’t consented for surgery yet the surgery is performed with an excellent outcome. Battery has still ocurred due to the lack of consent. When a patient says to stop poking him for a spinal anesthetic and the attempts are continued, that’s battery. Consent has been revoked. 


Case Studies

Bill related four case studies. One was a young woman who died after a hysteroscopy with circulating nurses untrained in hysteroscopy equipment. The gas flow and suction lines to the hysteroscopy machine were switched. The next was damage to a patient’s arm from an automatic blood pressure cuff. The patient revoked her consent to have the cuff on and it wasn’t immediately removed and damage resulted. Remember that patients never give up the right to revoke consent. The third case involved questionable sterilization indicators. Unsterile instruments were used (three questionable indicators were ignored) and the patient developed an infection and needed more surgeries. The fourth case was the most unbelievable (as odd as the train and phone booth case). A patient had an abdominal hysterectomy and had a retained lap sponge (counts were done and were “correct”). The x-ray showed the sponge to be partially in the bowel. One expert witness testified the sponge was entirely within the bowel but migrated out due to abscess formation. The prosecution then had to locate two additional expert witnesses to refute their first expert witness. The other two testified the lap sponge had partially migrated into the bowel (from the peritoneal cavity) due to abscess formation. The defense maintained a lap sponge wasn’t left in the peritoneal cavity. Because one expert witness said the sponge had been entirely within the bowel (and worked its way partially out due to the abscess), then that meant the patient had eaten the lap sponge! Yes, that was a real life defense strategy! At that point, I’d determine where my lawyer had graduated from (mail order law school?) and what his class ranking was (bottom or below?). Obviously, neither the patient nor the jury swallowed anything. The jury did find the hospital liable and damages were paid to the patient. Can you imagine being a member of that jury? We would have been hyterical! 

Anesthesiologists and Nurse Anesthetists 

Suzaane Ward attended the California Society of Anesthesiologists meeting in June. She was only invited to attend the House of Delegates (where everyone is addressed as Dr., Mr., or Mrs.). They wanted ORNCC’s opinion about Certified Registered Nurse Anesthetists (CRNAs). We need to solicit information for an informed reply. AORN shares a lobbyist with the CRNAs so AORN has no formal opinion. ORNCC is independent of AORN so we can have an opinion. “Medicare requires that physicians oversee nurse anesthetists, but last year adopted a rule allowing states to opt out of that requirement. Four — Iowa, Nebraska, Idaho and Minnesota — have done so. Many physicians oppose lifting such restrictions, fearing it could affect patient care, encroach on their job responsibilities or affect their incomes.”

"We think it's a reduction in the level of care for patients," says Dr. Barry Glazer, president of the American Society of Anesthesiologists. He says studies have shown that outcomes are worse, even when the nurse is working under the supervision of a surgeon, rather than an anesthesiologist. While the anesthesiologists association has fought the independent practice of nurses, the nurse anesthetists point to studies showing that the quality of anesthesia care has greatly improved in the past 20 years.”
“Nurse Anesthetists in Short Supply” by Julie Appleby, USA TODAY www.usatoday.com/money/health/2002-05-14-nurses.htm.

“Certified Registered Nurse Anesthetists(CRNAs) are advanced practice nurses who provide quality anesthesia care and services. CANA, Inc., is the professional organization for CRNAs in California (www.canainc.org).”

“Should Medicare Stop Requiring That Doctors Must Supervise Nurse Anesthetists? www.vote.com/vote/44809304. Pro - Nurse anesthetists complete three years of advanced training in anesthesia and are typically allowed by law to give anesthesia without a doctor's supervision. Let's not let a needless Medicare constraint hinder the pursuit of a more efficient system.
Con - It's a step in the wrong direction to allow nurses to deliver anesthesia without supervision. Studies show that there are needless deaths when anesthesiologists aren't involved. All patients deserve to have the best-trained person available do the job.” 

JCAHO and Anesthesia Carts

Suzanne Ward said the anesthesiologists received a waiver from the state about anesthesia carts not needing to be locked during the day while they’re working. You can refer to the State of California Health and Human Services Agency, Department of Health Services memo titled “Security of Anesthesia Carts” dated April 24, 2002 (www.calsocanes.com/anescarts0430.htm). It states carts may be unlocked during and in between consecutive surgical cases in a given operating room, as long as there are surgical services personnel in the immediate vicinity.


Board of Registered Nursing (BRN) Report

Monica Weisbrich reported that she hadn’t attended any BRN meetings (The last one was in Emeryville and she didn’t know where that was! We Bay Area people do!). She reported that Cynthia Johnson, an Assistant Professor at Cal. State Dominguez Hills, had been appointed to the BRN. There is still a vacany for a nursing practice person on the BRN. The BRN has no money. The state funneled money toward our electricity problem. There is no BRN funding for the Nurse Workforce Initiative (NWI) which is a three-year, $60 million project to address the nursing shortage in California. The Initiative incorporates both short-term and long-term measures to build and sustain a culturally diverse nursing workforce to meet California’s health care needs.  

Some exciting - and humorous - news is that the American College of Surgeons will define what surgical procedures need assistants. There are three categories: 
Almost always
Almost never
Some of the time. 
This is not a joke. Won’t this be helpful? The room full of OR nurses burst into laughter at this announcement. Can we say “fear of commitment?” Visit www.rn.ca.gov for more information about the BRN.

Tidbits

Arleen Whatley spoke about the Student Nurses Convention. It will be in Riverside the third weekend in February 2003. Volunteers are needed to staff a booth.

The AORN Leadership Conference in Denver in July had 250 total attendance.

Martha Smith (president of AORN SF/Marin) and Linda Rhyne (chairman of ORNCC) are working on a speaker for the ORNCC Chicago Congress lunch. Surgical Staff will still provide the folders (per Pat Culver of SSI). ORNCC is first on the list to get a room at the convention center for the lunch.

ORNCC still has 78 poppy pins left over from the Anaheim Congress. There are more pins “out there” but no one seems to know how many or who has them. Expenses have been covered but there’s been no profit from the sales. It was suggested and approved to sell the remaining pins at the student nurses convention for $5 each (the original prioce was $15). The pins are still for sale on the ORNCC web site (www.orncc.org) and on our web site (www.reocities.com/alamedacounty
/congress2002.html) at the end.

Arleen mentioned “Health Care's Human Crisis: The American Nursing Shortage” which was a study sponsored by the Robert Wood Johnson Foundation. You can read about it and also download the complete report (84 pages) in PDF (portable document format) at www.rwjf.org/newsEvents/nursingInterview.jhtml.

Many people announced their AORN chapters’ continuing education classes around the state. I announced our September 21 class and had fliers available.

The next ORNCC meeting will be February 1, 2003 near the Ontario airport.

Bill Duffy - National AORN Report

Bill volunteered to report on National AORN. He said National AORN was in good shape. We had a $900,000 loss but that reflects the “capitalization of assets” reworking of figures. Yes, our financial people used the same accounting practices that Enron and WorldCom used. But we had no underhanded practices and no theft by CEOs. Capitalization of assets is a standard accounting practice but AORN has decided to use another method that better reflects our finances, so the loss looks larger than it really is. The AORN Board now meets with the auditors (it never did this before!). Someone asked who our auditors are but they’re not any infamous accounting firm! We received $190,000 in a tax rebate due to a stock market loss. There’s been a large business-side clean-up of AORN lately.

Bill guaranteed temperatures over 65 F. for Chicago Congress the end of March. We were all impressed until he qualified that statement with “...in the meeting rooms.” What a comedian.

Legislative Report

Sally Sicherman gave the legislative report. AORN has changed legislative priorities. Patient Safety is the new focus. The theme for Perioperative Nurse Week (November 10-16) is "Perioperative Nurses: Your safety is our job... We take it seriously." See www.aorn.org/about/nurseweek.htm for more information.

“The Nurse in Washingtom Internship” (NIWI) was accepting applications for scholarship awards until October 1. NIWI was developed to reward individuals for their legislative efforts. NIWI was developed to prepare nurse-citizens to become more involved in the legislative process. See www.aorn.org/govt/awards.asp for more information.

Federal Bills

Visit http://thomas.loc.gov to view details of these bills

S 2590 Patient Safety and Quality Improvement Act (Introduced in Senate). To amend Title IX of the Public Health Service Act to provide for the improvement of patient safety and to reduce the incidence of events that adversely effect patient safety. 

HR 4889 Patient Safety Improvement Act of 2002 (Introduced in House). To amend Title XI of the Social Security Act to improve patient safety.

HR 3487 Nurse Reinvestment Act (Engrossed as Agreed to or Passed by House).  In summary, this act promotes advertisement of the nursing profession, loan repayment programs, scholarships, and increasing nursing faculty. According to the ORNCC report, this program needs $250 million but the funds aren’t available.

California Bills                  

Four of 14 bills pertaining to nursing passed. Visit www.assembly.ca.gov/acs/acsframeset2text.htm to view details of these bills.

SB 2008, Speier (Coauthor: Assembly Member Jackson), Nursing: Assumption Program of Loans for Nursing Education. Sent o the Governor September 9, 2002.

AB 2077. This bill would establish the Community College Nursing Education Fund

SB 1566. California Community Colleges Economic and Workforce Development Program. 

AB 1253. Pertains to mental health nursing


AB 1075. Pertains to nursing homes and staffing ratios.
                      
This is an invaluable site - www.aorn.org/govt/legdb.asp - for federal and state legislation.

According to Sally’s report, California is the last state in the union with nurse to patient ratios. California has no laws about mandatory overtime (SB 1027 “Overtime requirements: nurses and health care employees” was placed on inactive status August 31, 2002!) and California has no money for any programs.

Items of Note

San Antonio Hospital in Upland now pays their certified nurses $3000/year. Each and every year. That’s $8.22 per day (365 days). 

Suzanne Ward, the ORNCC web manager, is conducting a verbal abuse study. Do you have a policy on verbal abuse? Do you know an MD who has reformed his/her ways as a result of this policy? Please contact Suzanne at sfward@ix.netcom.com is you can help her.

By Mary Ritchie





Legislative & ORNCC News
August 2002 Newsletter

The next Operating Room Nursing Council of California (ORNCC) meeting is September 14, 2002, Saturday, 1000-1500 at the Hyatt Hotel in Long Beach. Look for more details on www.orncc.org which is only accessible with Microsoft Explorer (not Netscape). These meetings are very informative!

Legislative

The next Board of Registered Nursing (BRN) meeting is in your own back yard! It’s September 5-6, 2002 at the Holiday Inn Bay Bridge, 1800 Powell Street, Emeryville, CA 94608. Their number is 510-658-9300. Dates and locations may change, so please call 916-324-2715 for verification. Times were not listed on the BRN web site (www.rn.ca.gov/events/meetings.html). The next meeting is December 5-6, 2002 at the Wyndham Palm Springs Hotel, 888 E. Tahquitz Canyon Way, Palm Springs, CA 92262. Call the hotel at 760-322-6000.

I found it interesting to see there is a PACU nurse and a CRNA on the BRN Board. There are no OR nurses serving (www.rn.ca.gov/members/bdmbrs.html).

Through June 30, 2002, there were 268,337 active RNs, 18,508 inactive RNs for a total of 286,845 (www.rn.ca.gov/about/status.htm).

The California Strategic Planning Committee for Nursing (CSPCN) started in 1992 and ended June 28, 2002. This committee’s focus will continue through the newly formed Board of Registered Nursing, Nursing Workforce Advisory Committee. CSPCN members represented the leadership of more than 35 nursing and health care organizations and state agencies. Its purpose was to strategically plan for an appropriate nursing workforce to meet the needs of California’s people.

The CSPCN web site (www.ucihs.uci.edu/cspcn) has a brochure for the September 13, 2002 conference in Sacramento (which looks very interesting!). If you’re interested and can’t download it, I’ll do it for you (contact information is on page 2 in the lower left corner).

Colleagues in Caring (CIC) is still active (www.aacn.nche.edu/CaringProject).

CA BRN Legislative Updates and Proposed Regulations: www.rn.ca.gov/leg/legupdates.htm.

By Mary Ritchie


ORNCC Meeting February 2, 2002, Irvine, CA
April 2002 Newsletter


AORN Board Update, re: upcoming House of Delegates - Anita Shoup Board Representative

I.  Postponement of dues increase - will be coming back to the House for voting

II.  Governance Task Force
A.  Wants to remove all standing committees from the Bylaws and move to the  
           policy manual to allow for more flexibility
pros:  if you need a committee, you create one without needing to vote on  
           its creation at the House of Delegates
B.  Additional delegates at Congress
1.  All past presidents (national) at Congress would be delegates and able to
                 vote
2.  The Golden Gavel (national office holders but not past presidents) would    
                 be allowed to appoint 2 delegates
3.  Specialty Assemblies (12) would be allowed to appoint 2 delegates and 2
alternates

III.  One member/one vote Task Force
A study that was completed in October resulted in no mandate for changing the
           way that we currently elect our officers.
Pros:  Every member attending Congress would have a vote.
Cons:  Will we create an elite group of voters (those who can afford to go, those
           that can get the time off from work)?
     Voting without hearing/seeing the candidates.
Option:  “Extraordinary Voters” - members apply to become delegates.  The   
           number of delegates would be split equitably between the states and voters
           would be allowed to cast their votes ahead of time or at Congress?

IV.  Mentoring Task Force
A.  Nursing students will be allowed to attend Congress for FREE (no registration
           fees).
B.  A mobile perioperative course (Nursing 101) was designed to go out to the
           hospitals (target:  Orange County nursing schools).  The hospitals said no  
           so it will be provided at Congress at no cost to all who wish to attend.

V.  Motions Committee
Should one be created?
Motions need to be looked at before they are put before the House to determine if
           their is a fiscal attachment that may limit its implementation.  In addition,   
           the wording of motions needs to be looked at i.e. to explore vs. to  
           implement.  Why?  Some of the motions, mobile perioperative course for
           example, were worded as “Must be implemented” but could not because of
           opposition by the hospitals.

VI.  Selling things at Congress
No official word yet.  Issues include charging for sales tax and the fire code.
There will possibly be 20 spots at Congress.  Chapters would need to submit
           their names to headquarters and a drawing would take place to fill the  
           spots.

VII.  A new statement is in the work regarding patient/health care worker blood
           borne disease transmission.

VIII.  Smoke Plume Task Force will be submitting their report.

IX.  The Board is piloting an educational program to attract student nurses and non-
           member OR nurses to attend local AORN chapter meetings.

X.  Do we need to change our name again?
AORN - Association of periOperative Registered Nurses
Do people know who we are?  What does periOperative mean?

XI.  Dateline television program regarding medication error

Work in progress to include in our recommended practices “hazards in the OR”  
           including medications

XII.  A new Congress mailing went out recently to specifically attract Managers

By Felicia Williams


ORNCC Meeting May 5, 2001
June 2001 Newsletter

The Operating Room Nursing Council of California (ORNCC) met in San Diego May 5, 2001. It was a gorgeous spring day with perfect weather (and heavy traffic on the drive down!).

Please be aware any time there is mention of an ORNCC web address, itís only accessible with Microsoft Explorer. The following legislative information may be found at www.orncc.org /Legis. htm.

Key Legislative Issues

SB317: (Deborah Ortiz D-Sacramento) Expansion of Nursing Education Programs. This bill will expand the nursing programs run by the California State University and California Community Colleges beginning with $30 million assistance the first year to provide training for 4000 additional nursing students. The bill would also allow nursing students to apply for scholarships and forgivable loans if they work in under-served areas. The goal is to double the number of California nursing graduates in four years.

AB1140 (Thompson) This is the companion bill of SB317 introduced into the Assembly.

SB457 (Jack Scott D-Altadena) Introduced a bill that would facilitate student transfers from community colleges to the state university systems.

SB111 (Dee Alpert D-San Diego) This bill would expand an existing law which authorizes all medical assistants to perform specified services relating to the administration, performance of skin tests, and simple routine medical tasks including venipuncture for blood draw under the direction and supervision of a physician, surgeon or podiatrists to allow them to perform the same functions under the direction and supervision of physician assistants, nurse practitioners or nurse-midwives.

SB664 (Poochigian) Requires the Chancellor of the California Community Colleges to facilitate the education and development of new qualified registered nurses. The bill would require funds appropriated be expanded for programs such as, but not limited to, financially assist students pursuing associated degrees or transitioning from LVN to RN.

AB163 (Flores) Allow the use of tobacco settlement funds to provide school nurses.

AB87 (Jackson) Requires the Chancellor of California Community Colleges to award grants to community college districts for the purpose of developing curricula and pilot programs that provide training to licensed nurses including training in nursing speciality areas. Operating room nursing is specifically mentioned.

AB1075 (Shelley) Sets specific minimum staffing ratios for skilled nursing facilities with regard to direct care givers and licensed nurses.

AB1253 (Thompson) Amends the Evidence, Health, and Safety and Insurance Codes relating to the qualifications for psychiatric - mental health nursing. An advanced practice registered nurse certified as a clinical specialist is required for independent practice.

Mandatory Overtime Bills
SB1027 (Alarcon) Deals with Nurses
SB1208 (Romero) Deals with Physicians.
AB919 (Romero) Deals with Physicians.
For more information visit the California State Senate at www.senate.ca.gov and the California State Assembly at www.assembly.ca.gov.

Tricia Hunter Update

Comments from the Honorable Tricia Hunter, Executive Director ANA/C (American Nurses Association / California). Ms. Hunter is a former State Assemblywoman, a former OR Nurse, and an ORNCC member. This is a review of her legislative update in the February issue of ïThe Nursing Voice.E Here are some highlights:
* We have started a two year legislative session in California.
* New bills are introduced in January, revised in February with numbers assigned, then heard in March and April. Amendments can be made anytime during the two year cycle which is why grassroots efforts and lobbyists are important.
* Bills of interest to nurses are heard by the Health Committee. Assemblywoman Thompson chairs the Assembly Health Committee and she is an RN. The Senate Health Committee Chair is Senator Ortiz.
* Each House has created a Business & Professional Committee chaired by Assemblyman Correa and Senator Figueroa. This committee may also hear bills of interest to nurses and other health care professionals.
* ANA/C is interested in many health care issues, one being how to increase the nursing work force. ANA/C plans to work with the governor's office to build support for money for nursing education. ANA/C will be vigilant for bills allowing unlicensed assistive personnel to be substituted for RNs.
* ANA/C is closely watching the scope of practice issues for school nurses. Last year, one bill to allow teachers and support staff to give epinephrine in emergencies was vetoed by the governor and another to allow them to do finger sticks and give insulin died in committee.

Finally, Ms. Hunter closes her article calling for ANA/C members to be involved in the legislative process.

Federal Activity

* HR822 (Matt Collins) Medicare Certified Registered Nurse First Assistant (CRNFA) Direct Reimbursement Act of 2001. This bill would provide Medicare reimbursement for the surgical first assisting services of CRNFAs at 13.6% of the surgeon's fee.

Comments about HR822: There are 15 original co-sponsors for HR822 with only one from California - Lois Capps-D-Sacramento. Please write your legislators and ask their help in cosponsoring this legislation. AORN is particularly interested in obtaining support from the House Ways & Means or Commerce Committee members. AORN would like to get the support of Californians Pete Stark and Bill Thomas. There are sample letters and talking points at www.aorn.org/govt/letter.htm. Remember, even if you wrote last year, we need new letters dated 2001. Youíll need your new password to access this member only site. Go to www.aorn.org/mbrzone.asp or call 1-800-755-2676 if you donít know your password.

AORN is requesting member help with the GAO (Government Accounting Office) Study on Reimbursement of Certified Registered Nurse First Assistants which was mandated during the last congressional session. This report will look at quality, education requirements, and appropriate payment rates. Members are asked to identify surgeons and beneficiaries the GAO can interview personally about the quality of care issues. Please identify these people by name, address, telephone numbers, and e-mail address. We also need letters from surgeons and patients on the quality of care that RNFAs provide. The letters should be sent to your legislator with a copy to the GAO. Also, please send copies to Jim Irwin, Legislative Assistant, at AORN Headquarters.

Ergonomic Standards Rescinded: On March 6, 2001, Congress invoked the never-before-used Congressional Review Act to repeal the OSHA Ergonomic Standard which went into effect January 16. There are mixed feeling from various groups regarding this decision.

This report was prepared by Sylvia Durrance, Legislative Representative for the Council. Report updated March 24, 2001. Update at the ORNCC meeting May 5: seven of the 27 co-sponsors of the HR822 CRNFA reimbursement bill are from California! Thereís still a telephone and letter writing campaign so if you want to participate, contact Sylvia Durrance at work at 415-923-3569 or durrans@sutterhealth.org. She has a telephone script and sample letters to assist you. Seven states mandate RNFA reimbursement: FL, ME, RI, MN, KY, WA, GA. There are pending bills in MI, MA, TX (also licensing surgical techs), NY, WV (just Medicaid, not Medicare).

Tidbits of Information

The following information contains discussions at the ORNCC meeting in no particular order (I took copious notes but spread out all over!):

* A bill is being introduced to not have chiropractors declare anyone mentally fit to drive a truck. The truck driver who crashed into the state capitol building was declared mentally fit by a chiropractor!

* Ruth Schumacher (past national AORN president) organized a meeting of the 25-30 state council presidents at AORN Congress in Dallas. Some state councils were focused on educational topics rather than legislative issues. Concerns were voiced in our meeting about this assembly of state council presidents organized by AORN.

* We as a state council may now nominate candidates for national AORN offices. May 15 is the deadline. ORNCC will submit the names of Joy Don Baker for President-Elect; Deb Spratt, Nathalie Walker, Butch Fenton, and Bob Baxter for Board of Directors; Marilyn Sanderson for Nominating Committee. This may not be a complete list or the correct categories (I was writing as fast as I could!).

* It was suggested a letter be written to the AORN Board about making the Board membersí voting records public. This will become more important if ïone member, one voteE becomes a reality. We all need more information about the national officers and board members in order to cast informed votes.

* The American Nurses Association (ANA) web site (www.ana.org) has information about physical and verbal abuse on nurses by physicians, co-workers, and patients. An article stated people arenít entering nursing due to this abuse.

* The United Nurses Association (the Kaiser union) told Kaiser to stop distributing meaningless trinkets for Nurse Week and other noteworthy weeks. Theyíd prefer money.

Congress Luncheon

There was general surprise when I mentioned a chapter was unhappy with the lack of legislative issues at the Congress luncheon and there was talk of making attendance optional. The president was surprised to hear a chapter required attendance at the Congress ORNCC meeting. Many other people from various chapters agreed their attendance was also mandatory. It was agreed there would be a legislative speaker for the April 22, 2002 Congress ORNCC luncheon. Jackie Speir, Diane Feinstein, and Thompson of the State Assembly Health Care were possibilities. Another speaker must be held in reserve due to frequent last minute cancellations by politicians. So a legislator involved in a hot topic will be the speaker and everyone from all states is welcome to attend the ORNCC luncheon. A room for 200 will be reserved and there will be advanced publicity.

* Jane Kuhn from Los Angeles suggested inviting a recruiter to attend the ORNCC Congress luncheon to help offset the costs. The recruiter could make a short presentation and have an opportunity to meet people and forge contacts. The recruiter would gain contacts and ORNCC would profit fiscally.

* Eliminating the February ORNCC meeting and having the business meeting as part of the Congress meeting was suggested.


Congress Pins

I bought ten Congress pins for a discounted price so the chapter can resell them for a slight profit (or not - whatever the decision of the Ways and Means Committee is). The current trend is to have pins to sell to depict a theme for Congress. The 2002 Congress will be in Anaheim so California poppies were selected as the theme. The pins are about 2 1/4 inches high and 1.5 inches across. There are two orange poppies with a cream background on an oval pin. ORNCC bought 500 pins and chapters may buy pins from ORNCC in groups of ten. They may also be purchased on the ORNCC web site .


More News

* There were 350 registrants at the Student Nurses Convention. There were large numbers of recruiters (including out-of-state) ready to hire. Prison nursing seemed especially popular (especially with the male nurses).

* The California Board of Registered Nursing has no plans to revise the conscious sedation policies.

* Marilyn Sanderson is searching for volunteers for the 2002 Congress in Anaheim. There are 80 volunteers so far and she needs 200. Hopefully, each volunteer would have a two to four hour shift. Perioperative nurses from the entire state have the opportunity to join this effort in assisting the attendees to locate educational sessions and exhibits, and to serve as session assistants and moderators. Any ideas you have to distinguish the volunteers by their clothing would be greatly appreciated.

Congress 2002 in Anaheim is scheduled to begin April 21-25 and volunteers may be needed on Saturday April 20, 2002 as well. Please contact Marilyn Sanderson, 10728 Keith Street, Santee, CA 92071, 619-596-3381 at home, 619-528-3983 at work, and her e-mail is Marilyn.L.Sanderson@KP.org. See www.orncc.org/volindiv02.htm for a form to complete.

* The University of Southern California (USC) is closing the BSN program in 2001. The University of California at Los Angeles (UCLA) will reopen an undergraduate BSN program in 2002.

* The average wages of RNs rose 11%. Nurse managersí wages rose 21%. Those of a pharmacy director rose 20%.

* The treasurerís report was surprising. Due to the low Dallas Congress attendance, ORNCC lost $824.03 at the Congress luncheon. Thereís been a gradual decrease in profits from 1996-2000. There was a deficit of $3013 in 2000. The speaker in New Orleans in 2000 cost $3580 in fees and expenses! The Dallas 2001 and San Francisco 1999 speakers cost $500 each.

* There are 62 associate members (24 non-renewals) and 16 member chapters (out of a possible 27 California chapters). Visit www.orncc.org/ Memships.htm on Microsoft Explorer to join or contact the editor (see pages 2 or 8 for contact information).

*The California Strategic Planning Committee for Nursing/Colleagues in Caring (CSPCN/CIC) purpose:
1. synthesize data about the supply and demand for nurses as a basis for strategic planning
2. strategically plan for a nursing work force to meet the changing health care delivery needs of California's people
3. incorporate CSPCN expertise into an advisory function within a state agency.
www.ucihs.uci.edu/cspcn

Thereís a pilot program by CSPCN/CIC that encourages AD programs over BSN programs to get more nurses into the work force faster. California requires more hours for nursing. Nursing requires so many prerequisites that the normal two year AD program is stretched to three and one half years. The CSPCN/CIC is looking for ways to scale down the prerequisites.

The next ORNCC meeting will be in Oakland on October 6 (Saturday) 10 a.m. - 3 p.m. Contra Costa County will host because I didnít think it was fair for me to volunteer someone else to do the work (and I now live in Southern CA). There was discussion about having Anita Shoup as a speaker and providing contact hours (Contra Costa County would use their BRN provider number).

Submitted by Mary Ritchie


Operating Room Nursing Council of California (ORNCC) meeting February 3, 2001 in Irvine, CA
April 2001


The meeting occurred on a gorgeous day in Southern California and I was lucky enough to attend my first ORNCC meeting as a member and also as a representative of the chapter.


Announcements

The HCFA (Health Care Finance Administration) has said they no longer require MD supervision of CRNAs (Certified Registered Nurse Anesthetists) (for Medicare patients). The HCFA has been looking at this issue since 1999. Of course, the ASA (American Society of Anesthesiologists) opposes this decision and will appeal.

PANAC (PeriAnesthesia Nurses Association of California) has proposed a liaison with ORNCC.

No candidatesí speeches will be permitted at the Congress luncheon this year (there were many candidatesí speeches at Congress 2000 which took many of us by surprise).

Treasurerís Report was $6,026.83 in the checking account and $11,176.71 in the Franklin Fund.

There are 16 chapters as members and 35 member associates (individual members). From all these members, there was only one applicant for the ORNCC scholarship! It wasnít indicated if the lone applicant received the scholarship.

Congress News

News was given about the ORNCC luncheon at Congress. The continuing education topic is Domestic Violence. The luncheon is a Lone Star Platter with salmon, beef, and chicken. Texas does it big!

The Anaheim Congress 2002 pin was discussed and sample pins were passed around the room for everyone to examine (after lunch, we voted on the one we liked best). The pin that won was an oval pin that seemed like hardened beach sand, cream-colored, about two inches long and one inch wide, with two realistic (not stylized) orange poppies. A photo of the pin will be posted on www.orncc.org (still only accessible with Microsoft Explorer). Itís the one I voted for so you know it has to look good! There was discussion about price with ORNCC selling the pins to the chapters for a small profit and then the chapters selling them at a higher price for more of a profit. The minimum chapter pin order would be ten pins at $10 each and the chapters would sell them for $15. There was also discussion of getting matching pendants and earrings to create sets.

The volunteer coordinator for 2002 Congress is Marilyn Sanderson from San Diego. Marilyn wants your suggestions for Congress volunteer attire (people have suggested flip flops, Hawaiian shirts, shorts, and some people have been adamant about ïno scarves!E). If you have viable suggestions (the shorts and flip flops are not viable suggestions), call Marilyn at Kaiser San Diego 619-528-3983 or e-mail her at mlsanderson@aol.com

AORN would like our input into educational session content and speakers. They want to know what we want for the 2002 Congress. I have the form to complete if youíre interested in submitting your suggestions to AORN. Please e-mail me at marymac@hotpop.com to request the form.

Web Site and Congress

Suzanne Ward, the web master for ORNCC, wasnít at the meeting (she was taking a web class!) but it was announced for her that the web site will be updated with Dreamweaver within the next three months so it should be accessible with Netscape (itís only accessible with Microsoft Explorer now). If anyone has any legislative news or content for the web site, Suzanne would be happy to accept it. All the content on the site now has been done solely by Suzanne. She would love to have some help with content! Her address is sfward@ix.netcom.com.

There was a discussion about the seven chapters in California that have web sites. It was decided to recognize the chapters with web sites at the ORNCC luncheon at Congress. March 10 was the deadline set for delivering 200 copies of each chapterís web site (on a single 8x11.5 paper) to Judy Righetti or Sharon Hagler at the Hyatt for inclusion into the bag provided by Surgical Staff at the luncheon.

Los Angeles chapter was approached by AORN concerning ideas for the Foundation Gala at the 2002 Congress. Some ideas were a concert at the Anaheim Pond (thatís where the Anaheim Ducks play hockey) or Irvine Meadows or the Queen Mary.

More Announcements

There was one nomination for Vice Chair/Treasurer - Vickie Contraman. Therefore, Vickie is the new Vice Chair/Treasurer.

There is no more work being done about surgical tech licensing in CA. Itís a dead issue here so AORN terminated D. Brownsley (the CA lobbyist).

Letters to reps are needed for reimbursement for CRNFAs (Certified Registered Nurse First Assistants). AORN and CRNFAs are talking with the Government Accounting Office (GAO) about this issue. AORN would like names of physicians who support reimbursement of CRNFAs.

The educational/nursing preparation in ADN (Associate Degree in Nursing) and BSN (Bachelor of Science in Nursing) programs is very different. Tool kits were sent to California State Universities at Sacramento and Fresno and to Arrowhead Regional to pilot test differences in educational preparation. Leadership roles are being looked at. Outcomes are not being looked at but just the processes.

125 contact hours are needed for recertification, not 150 (every five years). A BSN is not required. A certification for OR management is coming.

The video, ïNursing: The Ultimate Adventure: PerioperativeE may be borrowed from ORNCC to show to high schoolers.

There was a discussion about chapter attendance and the factors influencing it (distance, fund raising, aging). The Los Angeles chapter has gone to quarterly meetings and an electronic newsletter. Jane Kuhn of the L.A. chapter asked if anyone was interested in a task force concerning membership and attendance (ïWhat is the chapter of the future?E). Apparently, no one was interested but it was evident we all suffer from the same syndrome - the same small number of people maintaining active roles in the chapter. (I learned L.A. has 289 members and 26 attend meetings. Thatís 9%. San Diego has 350 with 30-40 people attending meetings. Thatís 11%. Alameda County is in great shape with 13% (23 members out of 179 attending meetings). We all suffer from large geographic areas.) A common complaint (attention Donna Benotti!) was when member feedback was solicited, there was resounding silence. The member apathy is so great, no one cared enough to respond to surveys! In conclusion, someone stated that people need an incentive to belong to AORN - and that comes from the workplace (Thatís a sentiment I disagree with wholeheartedly!).

Thereís a scam going around about paying a company called Corporate Compliance from Sacramento $100 ($80 last year) to maintain a tax-exempt status. This is untrue and no one should pay this.

Board of Registered Nursing (BRN) Report

Conscious sedation issues are on no longer in the forefront. The ORNCC was asked to do a revision (ORNCC wrote the 1995 conscious sedation policy). The BRN cannot tell an RN what medications to give or not give. They can only dictate competencies and settings. The revision should be done by May (hopefully!). Itís taken over one year to develop this revision.

The ïrescueE part of the JCAHO (Joint Commission for Accreditation of Health Care Organizations) guidelines is that a person giving medications MUST know how to reverse whatever is given or done (such as over-sedation). This became effective in January 2001.

The next meeting is May 5, 2001 in San Diego.

Submitted by Mary Ritchie


ORNCC Tidbits
February 2001

Here are some highlights of the February 3 ORNCC (Operating Room Nursing Council of California) meeting (more details will be in the April newsletter):
* The BRN (Board of Registered Nursing) can't tell RNs what meds to give or not give (such as diprivan and ketamine). The focus must be on competencies and settings. The RN giving meds must know how to reverse the meds given.
* Continue writing letters to reps and senators about reimbursement for CRNFAs (Certified Registered Nurse First Assistants). If you know surgeons who are willing to speak in support of this, let AORN know.
* HCFA (Health Care Finance Administration) has mandated CRNAs (Certified Registered Nurse Anesthetists) no longer need physician supervision for Medicare patients. The ASA (American Society of Anesthesiologists) is appealing.
* The 2002 Anaheim Congress pin has been chosen. It's oval with an off-white background with two orange poppies. Each pin will sell for $15.
* The 2002 Anaheim Congress coordinator is Marilyn Sanderson from San Diego and she wants our ideas for the apparel for Congress volunteers. Hawaiian shirts with shorts and flip flops didn't go over well as a suggestion. If you have some ideas, contact Marilyn at mlsanderson@aol.com and 619-528-3983 at work. AORN also wants your suggestions for education sessions. I have forms to complete for session/speaker suggestions so e-mail me (marymac@hotpop.com) or call AORN (1-800-755-2676).
* 125 contact hours are needed for recertification now - not 150 (every five years). A BSN is NOT required to become certified.

By Mary Ritchie


Operating Room Nursing Council of California (ORNCC) Report, October 21, 2000
December 2000

The October 21 meeting was called to order by the chairman, Marilee Brehm, and began with everyone in attendance introducing themselves and their affiliation. I was chagrined to have to say I was a member of a ïdues-apnicE chapter (translated means we hadnít paid our dues!). The minutes of the May 20 meeting were corrected and approved. This was followed by some announcements that I thought might be of interest:
1. 65% of ORNCC members have e-mail while 74% of AORN members have Internet access.
2.  The Council will benefit financially from the ïManaging Today's Operating Room Suite ConferenceE recently held in San Francisco. Next year the Council will not have this revenue because the conference will move to Phoenix. Vice Chairman / Treasurer indicated she is developing a budget to determine where we can save money and generate revenues.
3.  I mentioned at our November 1 meeting that if you attended the movie, Nurse Betty, you can send in your ticket stub with the imprint of the movie title and the company will donate $1 to the Nurse Betty Scholarship Fund. However, the deadline was October 31 so I wonít clutter your pretty little heads with the mailing information I promised you.
4. There was a meeting of all State Council Chairpersons held at the AORN Leadership Conference July 7, 2000. There are around 27 State Councils. Chairman Brehm noted there is a significant number of AORN members-at-large in California. This could be a way to recruit new members to the Council and maybe our chapter?
5.  At the 2001 AORN National Congress, Council Chairmen will be recognized by wearing ribbons. Chairman Brehm announced that AORN is looking for a Congress 2002 Volunteer Coordinator. Individual chapters can submit names. This person would work closely with Headquarters staff to organize the 2002 Congress in Anaheim. (Any takers from our Alameda chapter?)
6.  The National Nominating Committee has finalized its slate of candidates. The only person from California running for a place on the Nominating Committee is Council Vice Chairman/Treasurer, Sylvia Durrance. (Hurrah! Sheís great and I would certainly encourage our chapter to support her.) 
7.  Our National Committee on Education representative is Susan Johnson. She may be reached at 5574 Sugarplum, Salem, OR 97306. Phone: 503-581-6491 or on e-mail at susan1j@juno.com.
8.  Chairman Brehm handed out a summary of the work of the AORN Governing Task Force. The purpose of this task force is to obtain and analyze data to make recommendations to the AORN Board of Directors regarding changes to better align AORN's governance (systems, processes, structure, and philosophy) to better position AORN in setting direction for the future. Chairman of this task force is Donna Watson and she may be reached at 800-755-2676 ext. 8311.

Legislative Report

Sylvia Durrance gave the Treasurer's report and a membership update. Currently, there are 86 associate members and 14 chapter members. She also announced there is money available for the ORNCC scholarship but no applicants. The application deadline was November 1. Monica Weisbrich, Gayle Sarlatte, Judy Dahle, Arleen Whatley, Marilee Brehm, and Trish Hunter provided the following information for the Legislative Report.

* HR 3911 was included in the BBA Refinement Markup Bill. This means the GAO will conduct a study to look at feasibility of including CRNFAs for Medicare reimbursement. Trish Hunter explained that a hurdle to overcome is the issue of setting a precedent for reimbursement for non-advanced nurse practitioners. Trish suggested we may want to think about making RNFA an advanced practice issue, i.e. either CNS or NP in the OR.

AB 655 Scott Bill. The recommendations were finally submitted but the governor vetoed all money in the budget to deal with them. This issue is currently at a standstill. It did raise consciousness about the shortage issue but thatís about it so it remains a problem not properly addressed. It is rumored that the CSU system did not want to deal with the changes so passed on the money being offered!

BRN meeting was held September 8. Most of the meeting was spent discussing the scope of practice for LVNs in the dialysis setting regarding administration of medications and IV fluids and the responsibility of RNs supervising them.

Conscious Sedation. Monica Weisbrich has been monitoring this closely. The current stance, by interested parties, is to wait and see how the new JCAHO standards will affect practice issues in the state. Weisbrich urged everyone to look at the new JCAHO regulations but most importantly, refresh your memory about your own scope of practice - look at the ïrescueE issue because this could save you. Remember, there are four levels of sedation and you must be qualified for the next level up/above when/where you are giving sedation. There are still issues related to the differentiation of short and long duration.

* OSHA Smoke Guidelines. We are still waiting for OSHA to release something about smoke evacuation guidelines. For more details you can consult the AORN web site at www.aorn.org/govt/smoke2.htm.

* Trish Hunter gave the attendees an overview of what is happening and what has happened legislatively in the state. She began with stating the positives and negatives of term limits. The negatives are it is hard to educate new legislators and you donít have long term relationships but one positive is RNs now have a chance because new legislators donít have ties to MDs.
Name Tag & Titling Bill was passed and is statute in Title 16. It impacts every licensed health care provider category including MDs. Credentials are to be placed on name tags and/or posted in offices.
Title of Nurse Protected Bill was passed that only LVNs and RNs can use the title ïnurse.E If unauthorized use of the word nurse is reported, it could result in a civil suit.
Overtime Bill AB 80 was passed. It enforces the eight hour/day and 40 hour/week rule. If a department wants to have ten or 12-hour shifts, they must get a three-quarters vote of the entire department. If someone doesn't want to work these hours, another position must be found for him/her within the institution. There can be no more than 16 hours of overtime worked by any employee. If no breaks or lunches are given, employees must be paid. There is no exemption for any RN (although Nurse Practitioners and Nurse Midwives finally did get one but not Clinical Nurse Specialists because their job description was deemed too vague).
Whistle Blower Bill was passed. This legislation puts the preponderance of evidence on the employer, not the employee. The accusation is assumed correct until proven otherwise.
Mandatory Overtime Bill will probably resurface during the next session but Trish doesnít feel it will pass because unions are against this.
Reuse of Disposable Medical Supplies (Is this the ultimate oxymoron?) came before the legislature but didn't pass. Now that there are Federal Guidelines this may be a mute point because the states can have higher guidelines but must have Federal minimums.
Staffing Ratio Bill passed. The language is still being drafted. It requires each hospital to set up minimum staffing for every unit based on acuity. This bill does not affect the OR because an RN is still required to be the circulating nurse but it has not dealt with the PACU. Itís questionable if PACU is the same as ICU. Everyone is submitting their ratios - i.e. SEIU, BRN, AHA. Researchers have been hired to look at various acuity tools. Publication of their findings is expected in January 2001.
* Budget Issues. The reason the Scott Bill failed was that the unions didn't like it. It was a California Hospital Assembly bill. Hopefully a bill will be introduced in the future to provide money for specialty education.

Leadership Conference. In 2001 the AORN Leadership Conference will be held in Washington, DC for the purpose of improving visibility and to educate the leaders of AORN about the legislative process. Make sure your chapter sends a representative.
       
Luncheon At Congress.  The 2001 luncheon will be held Monday, March 12 from 11:30-1:00 at the Hyatt Regency Ballroom. The speaker will be a director from a shelter for battered women.

New Council Web Site. Suzanne Ward introduced the attendees to the new web site. The Council has its own domain name so it can be accessed directly from the Internet or still from the AORN site. The URL is www.orncc.org. Please let Suzanne know what you like or don't like. This is a work in progress. (Editor note: This web site is wonderful but - for now - can only be accessed with Microsoft Explorer and not Netscape Navigator. Suzanne is working on that problem. The site has a lot of valuable information).

CNSA Convention. No information regarding where/when but assume it will be in Southern CA because it was in Northern CA last year. Sylvia will contact someone at CNSA in Orange County.  
     
The next ORNCC meeting will be held February 3, 2001 in Orange County and we hope to have Donna Watson as a speaker.
     
This report is a dual effort by Mary Ritchie and Pam Reuling. Pam never received the minutes plus copies of all the handouts to help clarify her notes from the meeting - was this because we were ïdues-apnic?E Anyway, Mary rescued Pam by finding the meeting minutes on the web which Pam edited, added to, deleted, etc. as she saw fit. Hope this all makes sense. If not, visit the web site directly at www.orncc.org. And if I donít see you at the December meeting, hope you have ïHappy Holidays!E


Submitted by Pam Reuling


Operating Room Nursing Council of California (ORNCC) Report, May 20, 2000
August 2000


HiDeHo! Here we go again - another stimulating report! Big Yawn!

The meeting began with the usual thank you to the host chapter, self introductions, and minute approval. It was announced that the new Legislative Coordinators will be Sylvia Durrance for Northern CA and Arleen Whatley for Southern CA.

The Treasurerís report bought up some interesting points of discussion. #1) Our main fund raiser has been O.R. Manager which will be held in Phoenix in 2001 and ORNCC will not be co-sponsor so will decrease our revenue. #2) The cost of our meeting luncheons have been increasing without an increase in charge to members so the Council is subsidizing more and more. #3) Membership consists of 85 Associates, 15 Member Chapters, 13 Presidents of Non Member Chapters, and one AORN Board Liaison. Although mailing costs are considerable for non- member chapters, it was felt it was counterproductive to cut them from our mailings as they would then be even more disenfranchised. It was proposed to raise the associate dues to $35 but chapter dues would remain at $35. The luncheon price and availability of continental breakfast will vary depending on meeting location and these details will be announced in the meeting notice.

ORNCC Scholarship still has no applicants to date and the deadline is November. So think about applying!

Legislative Report

Think Tank held re: AB 394 staffing ratios. There is much discussion about who participates as they want a small working group. Tricia Hunter who was present feels it a ïnon-issueE for OR and critical care as they already have staffing mandates.

Status of the Scott Bill AB 655 requiring UC, CSU, community colleges and private universities to come up with strategies for increasing nursing education and preparation in CA is now sitting on the CSU Chancellorís desk presumably being held up due to money issues.

CSPCN (CA Strategic Planning Commission on Nursing) is distressed about the hold up with the Scott Bill because funding could be lost so they are drafting a letter to send to the Governor. CSPCN also has a Competency Role Differentiation Team who is working to validate the differences and determine the competencies of nurses, as educators feel there is a difference in the roles and training of AA vs. BSN vs. MSN prepared nurses. They are also looking at the image of nursing.

Surgical Tech Issues

ïBad News/Good NewsE - SB 335 passed in Kentucky which allows techs to first assist and be reimbursed but it does include reimbursement for RNFAs also.

Delta College in Michigan has a class that can be taken on-line to learn how to first assist.

(Info received after our meeting but included in the minutes was that surgical techs voted on a recommended minimum level of education for a CST/CFA to be a BS but it was narrowly defeated. Whew!!)

HR 3911 - there are 18 cosponsors so far and AORN is encouraging Southern CA constituents to contact Bill Thomas in Bakersfield to encourage cosponsoring because he is on the House Ways and Means Committee (News Flash! News Flash! Your own chapter is now actively pursuing Pete Stark, who is on the House Ways and Means Subcommittee on Health, to see if he will consider cosponsoring. Evelyn Steen as his constituent and ïghost writerE Pam have requested a meeting in August during Congress recess.)

Congress Luncheon had excellent evaluations for the speaker and the lunch itself. However there were real concerns about candidates for national office using it as a forum. Heretofore council officers are to only give candidates a courteous nod of recognition, not a platform for a speech. Since Sharon Hagler and Judy Righetti did such a good job, their ïarms were twistedE to do the 2001 luncheon and train/mentor Linda Rhyme for 2002.

CNSA Convention booth was a real success - many nursing students stopped by for information and it was well staffed by ORNCC and AORN members from San Jose, Contra Costa (mainly Kaiser) and us/me. Next yearís convention will be in Southern CA.

ORNCC Web Site will now be handled by Suzanne Ward. Marilee, who started the web site, is now president so sheís passed on the specifics to Suzanne. The address is www.innercite.com/~marileeb.

National Committee would like to know how many periop nurses are in CA. The BRN does not have this information because the questionnaire that comes with license renewal is optional. This would be a great research for a grad student - any takers?

Certification Board is doing a survey re: nurses interested in going back to paper and pencil tests. Concern is that fear of computer use is deterring some from taking the test.

Proposed Definitions of General Anesthesia and Levels of Sedation and Analgesia are out. I have the eight-page document should anyone want to peruse it.

AORN State Council Affiliation for ORNCC has not been officially acknowledged either verbally or in writing. We have only rumors to the affirmative.
2002 Anaheim Pin is being discussed. This could be a fund raiser to replace monies lost from OR Manager Meeting in 2001. Design desired is decorative and universal. Ideas so far are poppies, ocean, sun, waves. Plan to have ready by October.

Surgical Focus Presentation by Stratos Institute encompassed viewing an educational video re: Advancing OR Management and giving feedback. This was a program developed in cooperation with AORN.

Next ORNCC Meeting is October 21 in Oakland at the Airport Hilton. Alameda County chapter is host so think about going as itís in your backyard. Hook! Hook! Weíre inviting Tricia Hunter to attend so maybe this will entice you to attend.

By Pam Reuling


Legislative News
April 2000

In a communication to our President Martha See from AORN dated February 9 (a week after the ORNCC meeting) was very exciting news. We did make a difference! Congressman Mac Collins (R-GA) is sponsoring a bill in the House regarding Medicare reimbursement of certified registered nurse first assistants (CRNFAs). It is HR 3911.

Congratulations AORN Governmental Affairs Team! Great news to have our bill, CRNFA Medicare Reimbursement HR 3911, introduced! All our hard work is beginning to pay off but we must not be satisfied. We have to continue contacting our Legislators. As Candace Romig said, it is particularly important to contact members of the Ways and Means Committee, since this is where the bill is currently. No one from California is on this committee but we still need to write to our Senators and members of the House of Representatives!

Here are the web sites to locate your representatives. They are also listed in the telephone book and in the newspaper (The San Ramon Valley Times lists all government officials names, addresses, telephone numbers, and e-mail addresses in every Sunday newspaper).

To locate representatives.

To locate senators.

Locally, The Honorable Barbara Lee is the representative from the 9th District (Oakland). The Honorable Ellen O. Tausher is the representative from my area (Danville). The resources mentioned will aid you in identifying your representative.

What follows between the rainbow lines was added to this web page 4/16/00 and was not included in the April newsletter.

House of Representatives for AORN Alameda County members


Barbara Lee
(D-9th District, Albany, Berkeley, most of Oakland)
414 Cannon House Office Building, Washington, DC 20515
202-225-2661, fax - 202-225-9817
1301 Clay Street, Suite 1000N, Oakland, CA 94612
510-763-0370, fax 510-763-6538
e-mail- barbara.lee@mail.house.gov

George Miller
(D-7th District, Benicia, Concord, El Cerrito, El Sobrante, Hercules, Martinez, Pinole, Pittsburg, Richmond, Rodeo, San Pablo, Vallejo)
2205 Rayburn House Office Building, Washington, DC 20515
202-225-2095
1333 Willow Pass Road, Suite 203, Concord, CA 94520
925-602-1880
3220 Blume Drive, Suite 281, Richmond, CA 94806
510-262-6500
1410 Georgia Street, Vallejo, CA 94590
707-645-1888
e-mail - george.miller@mail.house.gov

Pete Stark (D-13th District, Fremont, Hayward, Newark, Union City, San Leandro, San Lorenzo, Alameda)
239 Cannon House Office Building, Washington, DC 20515
202-225-5065, fax - 202-226-3805
39300 Civic Center Drive, #220, Fremont, CA 94538
510-494-1388, fax - 510-494-5852 (Hayward, North 510-247-1388) (Union City South 510-494-1388)
e-mail -petemail@stark.house.gov

Ellen Tauscher (D-10th District, much of central and eastern Contra Costa County and southern Alameda County)
1239 Longworth House Office Building, Washington, DC 20515
202-225-1880, fax - 202-226-5914
1801 North California Boulevard, Suite 103, Walnut Creek, CA 94596
925-932-8899, fax - 925-932-8159
100 Civic Plaza, Dublin, CA 94549
925-829-0813, fax - 925-829-7318
420 West Third Street, Antioch, CA 94509
925-757-7187, fax - 925-757-7056
e-mail - ellen.tauscher@mail.house.gov

California Senators
Additional information included here on 4/16/00

Boxer, Barbara (D - CA)
112 Hart Senate Office Building, Washington, DC 20510
(202) 224-3553
1700 Montgomery Street, Suite 240, San Francisco, CA 94111
415-403-0100, fax - 415-956-6701
e-mail - senator@boxer.senate.gov
Senator Boxer's web site

Feinstein, Dianne (D - CA)
331 Hart Senate Office Building, Washington, DC 20510
(202) 224-3841, fax- 202-228-3954
525 Market Street, Suite 3670, San Francisco, CA 94105
e-mail - senator@feinstein.senate.gov

AORN CRNFA alert page

Please send copies of your letters to legislators and any responses received to AORN at 2170 South Parker Road, Suite 300, Denver, CO 80231-5711. Additionally, please call AORN at (800) 755-2676 Ext. 233, if your Congressperson appears to be a strong supporter and a potential sponsor for this legislation.

AORN needs your help in seeking federal reimbursement for CRNFAs first assisting at surgery. Currently, physicians, physician assistants, and some nurse practitioners are being reimbursed under Medicare for performing this service - but not CRNFAs. The following explains the legislation being pursued and the steps that you can take to help ensure that this lobbying effort will be successful. Your support is critical.

Initial Focus of the Legislation

As many of you know, approximately ten months ago, AORN commissioned Muse & Associates, an economic consulting firm, to calculate the cost to the Medicare program for reimbursing RNFAs for their surgical first assisting services. You may recall that the initial cost estimate was more than $600 million. In order to reduce this number and to facilitate our legislative effort, the AORN Board of Directors opted to limit our initial legislative efforts to CRNFAs, thereby, decreasing the revenue estimate to $84.6 million. Our federal lobbyists Karen Sealander and Mike Romansky of McDermott, Will & Emery, along with Dave Hebert and Greta Todd at AANA, worked closely with the economic consulting firm to ensure that the final work product would buttress our efforts on Capitol Hill.

Support HR 3911, the Medicare Certified Registered Nurse First Assistant Direct Reimbursement Act of 2000

Please see the outline of a letter to write (please use your own words) to your legislators. All this information is on AORN's web site.

Sample Letter

Background Information

Original Alert

AORN Government Affairs page

By Pam Reuling and AORN Online


Operating Room Nursing Council of California (ORNCC)
April 2000

Ho hum, you say, another boring report on the last Operating Room Nursing Council of California (ORNCC) meeting in Ontario, CA on February 5. I know, I know but maybe just scan the headings to see if there is anything of interest to you. OK?

The meeting began with the usual i.e. welcome, thanks to the sponsoring chapter - East San Gabriel, introductions, approval of minutes, treasurerís report verifying financial solvency, update of bylaws and yada, yada, yada.

Membership Update

There are 15 chapters and 55 associate members. A proposal was made to standardize dues to one fee of $35. Associates currently pay $25 and chapters pay $35. This topic was referred to the incoming Executive Committee.

ORNCC Scholarship

Two $1000 scholarships were awarded. One went to Lora Lee Grutowski, CRNFA, for an advanced degree as Clinical Specialist geared to the OR and one went to Janice Wiggins, a perioperative nursing student who has already demonstrated personal strength in the OR.

Legislative Report

AB 675 has been revived. This bill deals with the licensure and regulation of health facilities by the State Department of Health Services (DHS) plus periodic inspections if the facility participates in Medicare and/or Medicaid  programs.  It requires unannounced inspections no less than once every three years. It also requires sufficient staffing to meet the individualized care needs of patients and the implementation of a patient classification system based on ongoing assessments made by registered nurses. It further requires DHS to make documents demonstrating compliance with these regulations available to the public.

Assembly Bill 655

AB 655, the Scott Bill, was signed in October 1999 and is fully funded.  It addresses the nursing shortage problem in California and directs the University of California, California State University, and the community college systems to develop a plan to produce more nurses.  This includes the education of specialty nurses who are in the greatest shortage, i.e. operating room, emergency room, and the units. This plan, with a budget, must be submitted to the governor by April 1. The Board of Registered Nursing called a meeting with the schools and various nursing groups to discuss this. Several ORNCC members attended. 

State Bill 595

ORNCCís project of working on a legislative effort with Jackie Speier is temporarily on hold. When we met with her in November, we did give input to her bill, SB 595 regarding conscious sedation regulations in acute care and outpatient settings; in particular, in one place the bill states ïlicensed personnelE and we recommended that ïregistered nurseE be substituted. 

Since our number one priority was the conscious sedation issue and number two was nursing education and now the Scott bill has been signed, we are taking a wait and see position as those were the two broad issues ORNCC had identified. 

Registered Nurse First Assistant (RNFA)

The other big issue is the licensing and reimbursement of RNFAs although that opens another can of worms as the saying goes. Let me explain why.  First and foremost, ORNCC wanted to focus on broad issues that affected all OR nurses rather than just one segment, i.e. RNFAs, so pursuing this issue would go against the wishes of ORNCC.  However, Jackie Speierís legislative assistant is willing to pursue this and Lora Lee Grutowski and Karen Selbach already have the bill written but Speierís office feels we need the support of the California Nurses Association (CNA). Remember - they pulled their support last year after SEIU Local 250, who represent the Surgical Technologists, objected. Plus AORN is now pushing for federal legislation. See the news flash regarding RNFA Pending Legislation elsewhere in this newsletter. AORN preferred we use our energy on the federal level rather than on the state. Oh me, oh my, so close and yet still so far with our great chance to write a bill for OR nurses!

Lobbyist

Discussion occurred regarding AORN hiring a California lobbyist, Donna Brownsey, and the fact that ORNCC was not contacted regarding this selection. Brownsey was recommended by CNA and was hired on a limited contract to monitor the activities of surgical technologists (STs) because there is some indication this group is pursuing licensure/registration. AORN was contacted regarding the lobbyist communication chain which resulted in the formation of a telephone tree to gain and disseminate information from the lobbyist.  California was targeted because AORN feels the STs are going to be very active in pursuing their issues in California. 

Conscious Sedation

More information is surfacing regarding conscious sedation, i.e. ER nurses and flight nurses giving muscle relaxants to take the edge off.  The American Society of Anesthesiologists is focusing more on office practice issues and are not aggressively tackling acute care settings and the who and where of conscious sedation. 

Assembly Bill 394

AB 394 (the bill passed regarding staffing ratios) - the legislature has mandated the state board to come up with these ratios. A think tank is being formed to work on this and ORNCC has asked to be represented in this group. 

CNSA

CNSA (California Nursing Students Association) Convention:  This was held Presidentsí weekend, February 25-27 in Burlingame at the Park Plaza. ORNCC was offered a speakerís slot and Alice Erskine volunteered to present. Contra Costa, San Jose and yours truly manned (Pam had ïpersonnedE and I just couldnít allow it as the editor!) the booth. 


RNFA

RNFA Report:  Gail Zerby-Cook expressed the RNFAís appreciation for ORNCCís continued support and that they understand regarding ORNCCís work with Jackie Speier needing to have a broad focus.

Other News

State Council Affiliation:  ORNCC voted to affiliate with AORN.
New Officers:  The chairwoman is Marilee Brehm and the secretary is Susan Kaneshiro.   
Congress Bylaws Change:  Opinions expressed did not favor deleting the two year continuous membership requirement to be a candidate for national office. 
Next Meeting:  Saturday, May 20 in San Diego.

By Pam Reuling


Operating Room Nursing Council of California (ORNCC)
December 1999

The frost is on the pumpkin once again and so it is time for the October 30, 1999 Operating Room Nursing Council of California (ORNCC) meeting report. I guess these reports have been so stimulating that Martha See wanted to share in the fun and therefore accompanied me to the meeting. Karen Selbach was also in attendance so Alameda County was well represented!

I gave a quickie rundown on some of the pertinent information at our November chapter meeting so I will now give a more in-depth report. Of course, I will still just hit the highlights so if you want more details, feel free to contact me.

Brenda Ulmer, President-elect of AORN, gave opening greetings and encouraged everyone to keep in touch with her as did Donna Watson, AORN Board of Directors, Liaison to ORNCC. Pat Patterson, Editor of OR Manager, extended thanks for the successful OR Managers meeting. Attendance was 528 (eight more than the Chicago meeting) and evaluations were high (75% excellent, 24% good, and 1% fair). All 44 in attendance introduced themselves including one non-nursing guest. More on that at the end!

Board of Registered Nursing (BRN) Report

Monica Weisbrich updated us on the conscious sedation issue. Some cases under local anesthesia are being booked for 10-12 hours and the monitoring nurses are feeling uncomfortable administering the great amount of IV medications that this necessitates. AORN Nursing Practice Committee, American Association of Nurse Anesthetists (AANA), and the American Society of Anesthesiologists (ASA) are reviewing their policies. A big discrepancy is what is considered short term. AANA defines short term as four hours or less; however, some MDs interpret it as up to 24 hours! ER MDs want to change conscious sedation to procedural sedation so they can lower the existing monitoring requirements. ASA is adamantly against this. They are also concerned about how loss of reflexes is defined. Both ASA and AANA feel medications should be listed that cannot be given by anyone without formal anesthesia training. They are primarily concerned about Dipravan and Ketamine, especially when Valium and Versed are added. The BRN is against listing any specifics because they want their policies to have great longevity and don't want to change them to add and/or delete specific drugs. JCAHO will also be consulted regarding this issue. So until all these groups interface and hash out policies and procedures - a word to the wise - nurses who monitor patients and give medications better know what they are giving and what to do if they get in trouble!

RNFA/Surgical Assistant/Tech Saga

ORNCC was invited to meet with the BRN to discuss the role of the Registered Nurse First Assistant (RNFA) and the duties of assisting. As a result of this meeting it was agreed that the RNFA, with the expanded role and additional training, is the person to be functioning as the first assistant and not surgical assistants! (Hurrah, I say!) The California Healthcare Association sent a letter to all hospitals advising them that Surgical Assistants (technicians) should not be functioning in this role in free standing facilities as well as in acute care settings. Dolores Jones, one of the RN Directors for Kaiser, sent a letter to all her facilities advising that the use of technicians should cease and desist. The Licensed Vocational Nurse (LVN) Board emphatically stated that LVNs may not first assist as this is outside their scope of practice.

Registered Nurse First Assistant (RNFA)

The Simi Valley surgical technician program contacted Gail Zerby-Cook. The incoming technicians are sure they can first assist and asked her if she had anything in writing to refute this. Gail was delighted to hear the above information and feels this should cover their questions. There is nothing new in their legislative arena but she did inform us that an MD from Southern CA is running for Assembly and is open to all health issues and is willing to meet with the Council. Gail feels it would be great to have someone knowledgeable about health present in the Legislature as it is very frustrating to present info to lay people who just don't understand all the ramifications and it is so time consuming to educate them as you go along. As Gail sees it, surgical technicians are still unrelenting in their pursuit of an expanded role, i.e. first assisting, circulating, and OR management. They have a lobbyist and are represented by Local 250 SEIU. This union is trying to get RNFAs to join! Donna Watson said there is a hospital in Vancouver, WA which has repositioned all RNs in the OR and is letting surgical technicians circulate. Their Council is looking into this. Therefore, this is not just an RNFA issue. But it is a money issue you know the saying: Money talks and BS walks! Since technicians are cheaper, hospitals are trying to cut costs wherever they can. First it's to use technicians to relieve for lunch breaks, then circulate with an RN overseeing two rooms, and on and on. The hospital's rationale is, "Do it until you're caught!" Gloria Fama said the California Nurses Association (CNA) has a lobbyist and is working to prevent the RN in CA from being moved out of the OR. Also Shannon Sutherland, attorney for CNA, is supportive of RNFAs. (Remember? She talked with us at one of our Fall meetings in 1998. I still have concerns regarding CNA's support since they were sponsoring the RNFA's titling and reimbursement bill but backed out when SEIU Local 250 said it conflicted with their support of technicians. This relationship and putting the union before the people they represent still bothers me!) The AORN Board of Directors (BOD) and the Association of Surgical Technologists (AST) BOD are in dialogue trying to work out their differences. Alice Erskine, who teaches an OR course for RNs as well as surgical technicians, feels we should work with technicians toward joint care of patients plus encourage them to go to nursing school if they want to practice nursing and then they could legitimately move into the circulating role.

ORNCC Scholarship Report

There are no applicants to date so the deadline has been extended to December 31, 1999. CA Strategic Planning Committee for Nursing/Colleagues in Caring Report The Nursing Summit meeting in Sacramento focused on strategies to confront the nursing shortage and still maintain the patient as our bottom line. Nursing education was one big issue, especially the need for more Bachelor of Science in Nursing (BSN) and advanced degree nurses. There are now 70% of nurses with Associate Degrees in Nursing (ADN) because there are 71 ADN programs and only 22 BSN and six RN to BSN programs in California. California nursing schools are turning away applicants because of a lack of funds to support the programs and AB 655, the Master Plan for Education, was vetoed because it was too costly. Nationally there are 798 RNs/100,00 population and in California, there are 566 RNs/100,000 - the lowest of all the states. However, we need to recruit quality and not just quantity. California Strategic Planning Committee for Nursing (CSPCN) is hiring an ad agency to promote nursing. They will target specific age groups as well as minorities to reflect California's diversity. It was stressed that nurses should be positive when talking about nursing and we should never turn down an opportunity to talk to junior and senior high school students about our profession.

Lunch With Jackie Speier

She was very dynamic and discussed many health care issues submitted by council members. These included HMO reform measures; barriers to advocating nursing issues; Balanced Budget Act of 1997 and its negative impact on health care; support for the nursing shortage; problems with conscious sedation in the acute care and ambulatory settings; proliferation of unionization of MDs and RNs and its impact on health care; AB 394 regarding staffing ratios in acute care settings and should it also address ambulatory settings; why the nursing homes and extended care bill was vetoed; influence of lobbyists and should we have one; how can our Council support AB 595 regarding accreditation of offices giving anesthesia; and RNFA reimbursement issues at the state level. She offered to work with the Council in supporting and/or introducing a bill regarding our number one priority. Gloria, Sylvia Durrance, and yours truly met with Speier's staff representative on November 16 to discuss these issues! Speier and her staff are not that knowledgeable about nursing issues in the health care arena but are willing to learn and are very interested in working with us.

JCAHO Report

In 2000 the Joint Commission will be increasing the number of unscheduled surveys and will be visiting on the off- shifts (3-11 and 11-7).

Legislative Report

Bills signed by the governor:
Bills vetoed by the governor:
Bills placed in inactive file:
Bills held in committee and under submission:
(Access this web site to get all the details on any California bill - www.leginfo.ca.gov/bilinfo.html)

National Committee Report

Bylaws change for vote at 2000 Congress is to eliminate the need to be a member continuously for two years before running for office, i.e. would only need to be a present member. Guidelines have also been established for campaigning for national office. A proposed web site (AORN Surgical World) is for patients to use to acquire knowledge about their planned surgical procedure. The Board of Directors (BOD) has asked an outside firm to look at updating the AORN logo per the request of many members. The BOD is also working on a statement regarding two hot topics of concern to members, i.e. the role of health care industry representatives in the OR and the reuse of disposable items.

Recommended Practices

Approved revised Recommended Practices (RPs) are: anesthesia equipment processing; traffic control practices; documentation; counts; and sterilization. RPs currently being worked on are: conscious sedation; packaging; hazards; environmental cleaning; sterile field maintenance; skin preps; positioning; and gowns and drapes. One RP, radiology safety, is complete but missed the publishing deadline and will be in the 2001 book.

Habitat For Humanity

AORN is assisting in building a house during Congress week. Look for more details in the Congress Bulletin. ORNCC donated $ 250 to the cause.

Public Guest

Josie Sanqunett talked about her chronic health history and why she has had a long connection with, and trust in, the health care community. She said she was so pleased to hear us say many times during our meeting that the patient was our main concern and patient safety was our bottom line.

The End!

As Abe Lincoln once said, "I am sorry for writing such a long letter but I did not have the time to write a short one." Ah, yes, the devil is in the editing. However I did do some as I gleaned this information from 13 pages of minutes. There were so many interesting topics that I thought would be of interest to our chapter members that it was hard to cut anything out. I have organized it with headings so hopefully it will help you scan the report to find your areas of interest.

By Pam Reuling ("Your Long Windedness")


Operating Room Nursing Council Of California (ORNCC)
May 15, 1999 Meeting in San Diego
August 1999 newsletter

Treasurer's Report: Ending Balance:
Savings - $335.24
Checking - $12,691.65
Franklin Fund - $10,226.51

Legislative Report:
Current bills in State Legislature -

RNFA Report: None

BRN Report:

  1. There was an RNFA presentation to the BRN Task Force March 24. This task force was composed of DHS, CAN, ORNCC, SST and the LVN associations.
  2. The Board of Medical Quality Assurance (BMQUA) was the entity that exempted Kaiser Hospitals from using UAPs for surgical assisting 20 years ago. They had no authority to do this. The Task Force will be meeting June 7 to discuss this issue. The BRN and ORNCC are not invited to this meeting.
  3. CNA did an informal poll for Kaiser asking if surgical assistants should be first assisting and if so, what would they be allowed to do. The survey showed an overwhelming no.
  4. IF YOU HAVE A UAP FIRST ASSISTING, YOU NEED TO CALL THE DEPARTMENT OF HEALTH SERVICES (DHS) AND TELL THEM YOU ARE AT HOSPITAL _____, ADDRESS, AND YOU HAVE A UAP PRACTICING MEDICINE.
  5. Anesthesia techs also need to be looked at in terms of what they do.

ORNCC Scholarship:
Karin Selbach and Marilee Brehm are recipients for this year.

CSPCN/CIC:
The California Strategic Planning Committee for Nursing (CSPCN) was formed in 1991 as a public policy committee. Monica Weisbrich attended their meeting on February 23 in Long Beach. Discussion at this meeting included:

  1. Pre-decision making process to enter nursing
  2. Retention of practicing nurses
  3. How to utilize retired nurses in recruitment and retention
  4. The Veterans Administration Hospitals' new requirements:
    a. the VA will be requiring all nurses presently employed and all new hires to have their BSN degree by 2003.
    b. The VA will be paying for the BSN education of presently employed nurses
  5. Current numbers of nursing programs in the state of California:
    a. BSN - 22
    b. ADN - 72
    c. Diploma - 0 (16% of ADN grads go on to get a BSN)

Congress Luncheon:
There were mixed reviews on the education program. People either loved it or hated it. Many felt the facility was too small. The majority felt the food was excellent. 189 people attended. 185 evaluations were received. The ORNCC is looking for speakers and topics for next year.

Web Page Update:
Marilee Brehm announced that a link has been added to Springnet. (The ORNCC web page) (The Alameda County web site also has a link to the ORNCC web site at the bottom of our home page.)

JCAHO: No report.

National Committee Reports:
National Committee on Education (NCE) - the Region VIII representative has developed a newsletter format for her communication to chapters.
Recommended Practices - the committee has proposed a new format for Recommended Practices. It will be out for review in August.

ACNL (ONEC):
Association of California Nurse Leaders (ACNL) is the new name for the Organization of Nurse Executives of California (ONEC).

October Meeting:
The next meeting will in San Francisco at the Hyatt on October 30. It will be in conjunction with the OR managers conference. Jackie Speier (D-Daly City) will be the speaker. She will listen to our discussion on legislative issues and will then speak on the legislative issues affecting nursing. San Jose and San Francisco chapters will host the meeting.

Open Agenda Items:

  1. State Council Chairs have been asked to attend the AORN Leadership meeting in Denver
  2. The AORN Board of Directors liaison to the ORNCC is Donna Watson
  3. The BRN has not given any guidelines on IVCS (defined as short term). As a RN, you can refuse to do cases that are not "short term." Since the BRN won't define the term, we as RNs can decide.

Submitted by Kathie Shea


Operating Room Nursing Council of California Report
April 1999 newsletter

The Operating Room Nursing Council of California (ORNCC) met February 6 at the Westin Hotel in Los Angeles. The meeting minutes were sent to Clenia Yadao.

RNFA Report: Regarding the bill for the Registered Nurse First Assistant (RNFA) Medicare Reimbursement in California: a legislator was approached to sponsor the bill but he/she declined so we're searching for another legislator. The California Nurses Association (CNA) does not support the bill because of the Surgical Technologist threat.

Congress Luncheon: March 29 (Monday) 1130-1300 in the Yerba Buena Ballroom. RSVP by March 13. Cost is $38.

Board of Registered Nursing (BRN) Report: Patient Abandonment flyer was shown. BRN had a computer crash. If you are due to renew your license this year, make a copy of your renewal and send it in by registered mail so you have proof. The law states your license is valid after the expiration date while there is a computer crash.

California Strategic Planning Committee: Is comprised of nursing groups who plan patient care. The council will have representation at the October 7 Nursing Summit and expenses will be funded. The representatives are: Toots Sweeney, Marilee Brehm, Suzanne Ward, Monica Weisbrach.

Student Nurses Convention Report: The convention will be February 19-21 in San Diego. The new ORNCC brochure will be displayed. The ORNCC banner will be displayed at the ORNCC meeting at Congress - $58. There was a list of schools and perioperative nursing courses.

National Committee Report:
Membership: Members are encouraged to look at the AORN web site and go to the new MemberTalk for membership news.
Awards: The Award for Patient Education was added this year.
Recommended Practices: The 1999 book will be available at Congress.
Education: There are new videos added to the list; Perioperative Nursing Course 101 - send for the brochure from AORN; Margie Spies wants some input on how best to communicate about her newsletter. Suggestions are to send it chapter presidents and to have it in a newsletter format.

American Nurses Association/California (ANA/C): Katherine Dodd has left.

Website: Access AORN Speciality Assembly and it will give you information about Council activities.

Leadership: Leadership Conference is June 11-13 in Denver. Itís partially funded by the AORN Foundation. One chapter member and the president-elect are encouraged to attend. Other elected officers may apply to attend if space is available.

Affiliation with AORN: Option three offers voluntary participation of the council through a written request to the AORN Board of Directors. The Council will remain financially independent. March 30, 1 p.m. to 2 p.m. is the State Council meeting.

AORN Foundation Survey for Major Capital Campaign for ïPatient FirstE Study: Preparing Perioperative Nurses for new Generation Service. Arleen discussed membership; she will respond as an individual, not as a council (Arleen is chairperson of ORNCC).

AORN Name Change: This was discussed and RN should be emphasized, not OR. Also read AORNís mission statement before deciding. Mission statement should include professional.

Candidate for National Office: Margie Barrow-Spies is endorsed by the ORNCC, National Committee on Education - Region 8.

Open Discussions: - Should the council invite non-AORN members to council meetings.
- Council should keep an open mind to reach out to people who are involved with health care personnel who make key decisions about the daily operations of patient care, e.g. administrators, medical directors. This will be discussed again at the May meeting.

Political Action Committee: Pros and cons will be discussed at the forum. Please read the pre-Congress issue of the AORN Journal.

ORNCC New Bylaws Change: Associates may now vote on issues.

Sylvia Durrance: She was elected Vice-Chairman/Treasurer of the ORNCC.

Specialty Conference: It is September 29-October 2 in San Diego. The Council was asked to help with registration, etc.

Future ORNCC Meetings:
May 15 - San Diego
October 30 - San Francisco

OR Manager Meeting: October 27-29 - San Francisco

Information from the official minutes of the ORNCC meeting.


News Flash! News Flash!
February 1999 newsletter

Although the formal comment period to HCFA has passed, it is NOT too late for nurses and concerned citizens to voice their concerns regarding the rule changes proposed by HCFA - mainly the rule that would eliminate the requirement of having a registered nurse supervise the activities in the OR. So if you have NOT made a response or would like to respond again, you and your friends, neighbors and relatives are encouraged to contact your Congressional representative and request that they ask HCFA Administrator, Nancy- Ann Min DeParle, to retain RN supervision in the OR. Again, the talking points are that it is critical to the health and safety of surgical patients that assistive personnel who perform scrub and circulating tasks in the OR be supervised by professional RNs. Otherwise, the quality of patient care and surgical outcomes will suffer. If you or a loved one are in the vulnerable position of undergoing surgery, you should be able to rely on the skills, knowledge and expertise of the RN in the OR.

By Pam Reuling


Operating Room Nursing Council of California
October 31, 1998

December 1998 newsletter

Witches and goblins and nurses, oh my! Halloween day found us all assembled for the Fall meeting at the Hyatt Regency in San Francisco hosted by our own Alameda County chapter. This was the weekend following the O.R. Managers' meeting which had the highest attendance ever (600+) for a West Coast meeting and even exceeded the Chicago meeting this year!

AORN Lobby Days 1999 in Washington, D.C. will be held February 3 to 5. Registration forms are available.

Bills

The Legislative Report by Marilee Brehm included an update on some of the bills discussed at our May meeting.

AB 695 which addresses staffing ratios of acute care settings and includes the scope of unlicensed personnel. It passed the Assembly and was sent to Senate Health Committee for approval. It was amended to require the Department of Health Services to establish staffing ratios by the year 2000. It has since failed the vote and is dead for now.

SB 1816 would appropriate funds from the Board of Registered Nursing to be used for continuing assessment of the demographics of the nursing work force in California in relation to the population of the state and make recommendations to the legislature regarding nursing education and training programs. It passed in both the Assembly and the Senate. It was vetoed by Governor Wilson September 11.

AB 2048 addressed availability of criteria required of Health Maintenance Organizations (HMOs) for approving or denying funding of specific procedures or conditions and the accessibility of this criteria to the public. It permitted HMOs to charge reasonable fees for this service.

RNFAs Meet with CNA

A group of Registered Nurse First Assistants (RNFAs) met October 15 with the California Nurses Association (CNA) to discuss sponsorship of a bill to secure fee-for-service for RNFAs. They have asked for ORNCC support. They are seeking an author. Nothing will happen with this until the Assembly meets again the end of January.

ANA vs. ANA/C

The American Nurses Association/California (ANA/C) is struggling. Politics are afoot - ANA is not supporting ANA/C because ANA/C did not support Beverly Malone, the current ANA President. ANA/C is encouraging nurses to join to help boost numbers to increase their influence at the national level. Catherine Dodd has resigned as Executive Director of ANA/C.

AORN Issues

Issues discussed at the last National AORN Board meeting included the incorporation of state councils into AORN, AORN name change, forming a PAC, and changing the AORN Mission Statement. So far, these issues are an ongoing discussion but may come up in the House of Delegates.

ORNCC Web Page

Marilee Brehm has drafted a home page and will continue to work on this project. She will contact our own Mary Ritchie for assistance as Mary has already sent her some guidelines.

AORN News

There are currently volunteers for the 1999 AORN Congress representing 23 California chapters. Our chapter has 30 volunteers so far which is the most! Hurrah for us! A survey will be sent to all the volunteers seeking information to assist the planners in making accommodating assignments.

Candidates for national office are:

President-Elect:
Janet Lewis (OK)
Brenda Ulmer (GA)
Sherry Voss (VA)

Treasurer:
William Duffy (IL)
Maryann Mawhinney (PA)

Board of Directors:
Margi Barrow-Spies (CA)
Katherine Donahoe (PA)
Sharon McNamara (NY)
Patricia Mews (MO)
Sheila O Connor (LA)
Anita Jo Shoup (WA)
Donna Watson (WA)
Vivian Watson (MS)

Nominating Committee:
udith Clayton (GA)
Nancymarie Fortunato (OH)
Charlotte Guglielmi MA)
Penny Krug (AK)
Nathalie Walker (LA)

California Luncheon

The California luncheon topic at Congress will be "The Conflict Between Word and Image" - a lively and humorous presentation on improving communication by Dr. Leonard Shlain, M.D.

Clenia Yadao and I attended this ORNCC meeting along with Claire Rozman. Evelyn Steen came later for the volunteers' meeting and the four of us enjoyed an early dinner and caught up on all the news. A good time was had by all. Wish you all could have been there. Until next year, have a Happy and a Merry!

By Pam Reuling


Operating Room Nurses Council of California - May 30
August 1998 newsletter

Thank heavens the minutes of this meeting arrived before I had to write this report. After our dreary El Nino winter, I found my eyes (with mind following!) frequently drifting past the speaker to the bright sunshine dancing off the multitude of sailboats in San Diego.

Our new chair, Arleen Whatley, welcomed us and thanked exiting Council Chair (Judy Dahle) and Secretary (Marilee Brehm) for their excellent service. Marilee along with Susan Kaneshiro are now the Legislative Committee Co-Chairs. Their report included Nursing Legislation:

AB 695 addresses "Health Facilities: Nursing Staff" which includes scope of unlicensed personnel, i.e. defines tasks they cannot do, e.g. "sterile procedures related to direct patient care" and "moderate complex lab tests." It sets staffing ratios - e.g. "One RN not circulating for more than one OR" and one RN to two patients in ICU, ER, and PACU. It passed from the Assembly to the Senate June 3.

AB 1776 is the Vehicle License Fee Repeal. Portion of this fee goes to the counties to help fund medical care and mental health services for the indigent. Although woefully under funded, it did help and this repeal eliminates these funds with no suggested alternatives.

AB 2429 was heard in the Assembly Health Committee April 21. It's designed to meet the shortage of specialty nurses through educational programs sponsored in part by community college funds. It proposes funding for educating nurses in Critical Care, OB, Peds, NIC, and OR. Programs would require partnerships between service and education.

AB 2496 addresses minimum requirements for perfusionists (none currently exists).

SB 1816 provides appropriation of $145,000 for BRN to conduct a study of the nursing work force in relation to the population of the state and make recommendations to the legislature regarding the nursing shortage. It's expected to institutionalize work of CSPCN (CA Strategic Planning Committee on Nursing) and provide funds for nursing education. It currently is one RN/100,000 population in CA which ranks last in 50 states It passed from the Senate to the Assembly May 27.

HMO Legislation

AB 607 requires HMOs to give information on coverage and provide phone numbers to enrollees. It also stresses the importance of reading disclosures. It was signed by Governor Wilson April 16.

AB 2048 allows public access to criteria used by HMOs to authorize or deny specific procedures/conditions although there may be a charge for this. It passed the Assembly May 27, read in the Senate May 28 and assigned to committee.

AB 2515 establishment of Health Care Access Task Force to study current HMO situation and submit recommendations by January 10, 2000. It extends the Health Care Improvement Task Force until the year 2000. More detailed information on these bills is available from me, Sacramento and/or various web sites.

Other Information of Note:

RNFAs are working to require insurance companies to reimburse RNFAs for covered procedures. BRN has concerns with safety and welfare issues for consumers. BRN has taken information from AORN, specific standards for procedures from UCSD and more generics.

Oh, that reminds me! Our next ORNCC meeting is right across the Bay at the Embarcadero Hyatt Regency Hotel so "Ya'all Come." It's on October 31 and costumes are welcome! Alameda Chapter ("Us'ins") are hosting. Help! Help!

Submitted by Pam Reuling


Get Ready To Put Pen To Paper
February 1998 newsletter

At our January 7th AORN meeting, Evelyn Steen brought to our attention a notice in the Federal Register regarding HCFA's proposed changes to the rules governing surgical and anesthesia services. Copies of what Evelyn found on the AORN web site were made available to those in attendance. After our meeting I talked with Candace Romig, our Legislative Coordinator at AORN in Denver, and obtained a five page abstract/summary regarding these changes from her. I also obtained the full proposal from the Internet - all 77 pages - if anyone should want to peruse it at our next meeting.

Our legislative committee has met and each of the five of us are writing a sample letter and bringing copies to our February 4th meeting to help initiate a letter writing campaign. We hope each and every one of us can write his/her own individual letter using these samples as a guide and adding his/her own personal experience.

We have about ten days after our meeting to get them in the mail to meet the February 17 deadline. Hopefully, we can involve other nurses at our workplaces in this letter writing campaign as well.

See the article on the main web page that Mary Ritchie found on the perioperative listserve for more details about this proposal, where to write, what to reference and the deadline. E-mail Mary at ritchieg@bigfoot.com for Pam Reuling's phone number to obtain sample letters and more information.

Submitted by Pamela Reuling


Operating Room Nursing Council of California
October 4, 1997 Meeting
December 1997 newsletter

Here is an update on the bills discussed at the May Operating Room Nursing Council of California (ORNCC) meeting and printed in the June newsletter:

SB 827 - Leroy Greene bill regarding the Sunset Review of the Board of Registered Nursing (BRN) was finally signed by the governor in September! It extends the BRNís existence until July, 2004. No change was made in the board membership (Greene had proposed having more public members added).

AB 115 - Knox bill regarding the Industrial Works Commissionís decision to change the work week based on a 40-hour week rather than an eight-hour day. It has become a two-year bill because it did not pass out of committee before the end of the legislative year, i.e. passed out of Assembly but is still in the Senate as it has had a lot of opposition. If it does not pass out of the Senate before the end of January 1998 it dies! Hurrah, the ïWicked WitchE! Oops, sorry - wrong holiday!

AB 90 - Cuneen bill regarding Clinical Nurse Specialists (CNS) was signed by the governor in August!

AB 497 - Wildman bill regarding response times when calling an insurance provider and response times for nurses when patients are in an acute care facility. The language regarding nursing response times has been removed from the bill. It is now in the Committee on Insurance and awaits a hearing. It has also become a two-year bill.

AB 515 - Ashburn bill regarding psychiatric technicians was also signed by the governor in September but its final contents were much more palatable than the original bill. All language allowing starting and/or superimposing intravenous fluids, blood or blood products plus administering injectable medications was removed. The remaining language allows for administering skin tests and requires that they treat any emergencies ïwithin the scope of their practice.E

AB 695 - Kuehl bill regarding nursing staffing ratios in acute care facilities. In June the author asked for ïreconsiderationE which is requested when a bill is in danger of being killed. The BRN continues a watch stance.

Liz Figueroaís three bills addressing womenís health care issues:

AB 12 - Length of stay for mastectomy patients. Itís in the Assembly concurrence file, i.e. the Senate passed with amendments and those amendments must be concurred in the Assembly. Therefore it becomes a two-year bill.

AB 34 - Insurers not funding services such as prenatal care and pap smears consistent with nationally recognized standards. It remains in Senate Insurance committee and therefore is also a two-year bill.

AB 38 - ïDrive-throughE deliveries. It was signed into law in August and went into effect immediately!

New Bills:

SB 571 - Wrightís bill regarding radiology technicians. Slipped by a lot of people monitoring nursing and health bills and was signed into law in September! It allows radiology technicians to perform venipuncture in upper extremities and give dye for contrast studies. It essentially eliminates the registered nurse in the x-ray department and brings up real safety issues with patients undergoing diagnostic imaging procedures.

AB 1545 - This information was discussed in May and is now a bill in the Committee on Human Services. It allows ïincidental medical servicesE (i.e. the care of colostomies, ileostomies, urinary catheters, gastrostomies) to be performed by unlicensed care givers but who are trained by licensed health care professionals. Bears watching!

Submitted by Pamela Reuling


Operating Room Nursing Council of California
May 17, 1997 Meeting in Oakland
June 1997 newsletter

Sandy Bean updated us on current legislation. There are now 1650 bills in the legislature and about one-third of these bills deal with health care. At our February 1st meeting, 425 bills had been introduced with 36 of them health related. So our health issues are very much in the forefront in Sacramento!

The main Senate bill of concern for us is SB 827 by Leroy Greene which gives the nod to the Board of Registered Nursing (BRN) and extends the BRNís existence to 2004-05; i.e. no ïSunsetE for at least six years. Hurrah! However, our celebrating is fleeting as he feels the Board should have more public members which is good in theory as the BRN is to protect consumers. Our concern is that the public members do NOT understand all the ramifications regarding health issues and they turn over frequently so it is difficult to keep them educated so they can make informed decisions. Oh me, oh my! Our work is never done!

Assembly bills of concern for us are:

AB 115 by Wally Knox regarding: work week basis, i.e. eight hours/day which the Industrial Welfare Commission (IWC) repealed. In a nutshell - if you have a collective bargaining unit, it will not affect you. If not, and you work over ten hours, you have to have overtime. This is all based on ten hours, not 12 hour shifts. This merits watching as it could have a big fiscal impact.

AB 90 by Keeneóthis is the Clinical Nurse Specialist (CNS) bill mentioned in the last newsletter; i.e. who can call themselves a CNS, etc.

AB 497 by Scot Wildman ( and he IS a ïwildE man!) This bill has two parts.

  1. Persons enrolled in health plans must have their calls answered in five minutes and if they have an urgent problem, be seen on the same day.
  2. Nurses response times: nurses will have 60 seconds to respond to a patient in ICU. Nurses will have five minutes to respond to a patient on the ward. Sandy Bean feels this is a good idea gone bad!

AB 515 by Roy Ashburne - bad bill! This bill has already passed out of the Assembly. It involves psychiatric technicians who want to give IM medications and PPDs, hang IVs, IVPBs, blood and blood products, etc. They also want to be seen as entry level professionals! The BRN and Nurse Coalition have taken an opposed stance.

AB 695 by Sheila Kuehl - complex bill. It is a Proposition 216 issue regarding: staffing ratios and mixes in acute care. California Nurses Association (CNA) is pushing this bill as it delineates what CAN & CANNOT be delegated. Surgical technologists (and some managers!) are upset with this bill. The BRN has a ïWatchE stance. Governor Wilson says he will veto anything with CNAís name on it because CNA did a hit campaign on Tricia Hunter (an OR nurse and a Representative!) and she lost when Wilson wanted her in! Arenít politics fun?

Sandy Bean wrote letters to Liz Figueroa concerning her three bills regarding: womenís health, i.e. preventative reproductive health and length of stays after childbirth and mastectomies. She also tried to educate Liz regarding different types of mastectomies as Liz did not appear to know there were different types.

Monica Weisbrich reported on the BRN Advisory Board. Items of interest were:
School nurses must go to the Teachers Board to be certified. ïVolunteersE are performing ïincidentalE medical care in schools, i.e. tube feedings, catheter care, etc.

The next BRN Advisory Board meeting is June 4.

The National Institute of First Assisting that is recruiting surgical technologists as well as RNFAs is NOT on the Advisory Boardís agenda but ïa little birdE suggested they would discuss the subject if someone brought it up. Monica will be sent by ORNCC to play the ïDevilís AdvocateE! The plot thickens!

Judy Dahle went to a ïnuts and boltsE of Title 22 which gave good guidelines regarding: patient classification, staffing, and competencies of registry nurses used in OR.

The AORN National Committee on Recommended Practices is revising eight practices - they also have a charge to have AORN guidelines on latex.

Sandy proposes ORNCC develop a web page - she will make an official proposal at the October meeting.

To quote a famous bunny, ïThatís all, folks!E

Submitted by Pam Reuling


Surgical Technologists
June 1997 newsletter

As reported in the last newsletter, our legislative committee did meet and brainstorm regarding the policy on Surgical Technologists. Amy Saft graciously took notes & miraculously compiled and submitted the following information from our ïramblingsE. We thought you might like this list for discussion with your cohorts. Please feel free to contact us to edit, add, delete and/or share your thoughts on the issue.

Reasons for supporting certification but not licensure is that surgical technicians have:

  1. No baseline or required certification that gives standard competencies.
  2. A knowledge base that is technical, not wide-based.
  3. No perioperative or broad scope of continuum of care.
  4. No knowledge of nursing process.
  5. No assessment skills.
  6. No pathophysiology knowledge base.
  7. No psychosocial or advocacy education.
  8. No pharmacology and/or lab test knowledge.
  9. No management education.
  10. The need for the surgeon to be present for the total case, i.e. setup, turnover, etc. if licensed under the Medical Board

Submitted by Pam Reuling


Surgical Technologists
June 1997 newsletter

The Legislative Committee met recently to discuss some literature sent out by AORN regarding the issue of regulation of surgical technologists (STs). AORNís official position on this issue is that it opposes state licensure or registration of STs. AORN feels STs are not independent practitioners so there is no need for state regulation of their practice. STs always work under the direct supervision of a physician or an RN. Delegation of designated tasks to unlicensed care providers, with the accompanying responsibility for public safety related to care, is part of the scope of practice of physicians and nurses. The educational preparation of the certified surgical technologist (CST) does not include the nursing process or judgment about patient care needs or the evaluation of patient care processes and outcomes. AORN supports the delegation of nursing tasks as provided for in the law as implemented through guidelines developed by the nursing profession.

There is no current legislation on this issue but there have been attempts by the Association of Surgical Technologists (AST) in two states to legally broaden their scope of practice. In Washington, there was a House bill introduced to put STs solely under the supervision of a licensed physician. The bill describes the roles of STs as scrub person, circulating person, and assisting the physician during surgery. This bill was opposed as written but the AST was encouraged to resubmit similar legislation. In New York, the STs drafted language that would provide them with state registration as ïregistered special assistants.E under the state health codes. STs would prefer this designation because the health codes say that only registered persons may be delegated certain tasks. This change would enable them to be under the jurisdiction of the Board of Medicine and allow them to function under a licensed physician. The New York Council of Operating Room Nurses is continuing to monitor this issue.

As a committee, we felt that although we support universal certification of STs to ensure a baseline education and competence requirement, we oppose the registration or licensure of STs. We also oppose the ST functioning solely under the jurisdiction of the physician and in the roles of a circulator or first assistant.

Since there is no current legislation regarding this issue, it is useless to write letters to members of Congress now, but we will keep AORN members updated as changes evolve or new legislation is submitted.

Submitted by Amy Saft


Home Page of AORN Alameda County
Other Committees
Minutes of the Monthly Chapter Meetings and the Board of Directors' Meetings
Research Questions
Presidentsí Messages
Newsletter Articles


Updated January 8, 2003

Created January 24, 1998 by Mary Ritchie, RN, CNOR

Association of periOperative Registered Nurses, Alameda County, California

Home page URL is: http://www.reocities.com/HotSprings/9007


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