RN Circulator Talking Points What is a Circulator: The RN circulator is the only licensed professional with the ability and responsibility to be completely and comprehensively patient-focused during the procedure. • The perioperative RN provides quality nursing care through patient assessment, diagnosis, outcome identification, planning, implementation, and evaluation. • The nursing process is composed of these essential functions and is essential to achieve optimal patient outcomes by predicting, preventing, and managing adverse outcomes throughout the operative or invasive procedure. These activities are part of the nursing process and cannot be delegated. • The circulating nurse is responsible for managing all nursing care within the operating room, observing the surgical team from a broad perspective, and assisting the team to create and maintain a safe, comfortable environment for the patient’s surgery. • Legally responsible for Patient care in the OR Legal Documents: permits, authorization for care, correct site, etc. Documentation of OR procedure and care. Case set-up and preparation Appropriate positioning with assistive devices/equipment Maintaining sterile field Administration of medications Patient care: physical, emotional and spiritual Supervision of ancillary personnel Proper equipment function/safety checks • Roles found in surgery and who usually fills those roles Physician/surgeon Anesthesia: physician or CRNA Scrub person: Surgical Technologist or RN Assistant: Physician, PA or RNFA What is AORN? • The Association of periOperative Registered Nurses (AORN) is the national association committed to improving patient safety in the surgical setting. AORN is the premier resource for perioperative nurses, advancing the profession and the professional with valuable guidance as well as networking and resource-sharing opportunities. AORN promotes safe patient care and is recognized as an authority for safe operating room practices and a definitive source for information and guiding principles that support day- to-day perioperative nursing practice. • AORN, as the recognized leader in patient safety, promotes quality patient care by providing its members with education, practice standards, consultation services, and representation. AORN is comprised of over 40,000 perioperative RNs in approximately 6,700 hospitals and 3,500 ambulatory surgical centers in all 50 states and around the world. • Mission: The Association of periOperative Registered Nurses (AORN) mission is to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses. AORN will collaborate with professional and regulatory organizations, industry leaders, and other healthcare partners who support the mission. RN Circulator Talking Points • Vision: The Association of periOperative Registered Nurses (AORN) is the leader in advocating for excellence in perioperative practice and healthcare. • AORN sets the ‘Gold Standard’ of practice for nurses in the OR. • AORN’s primary legislative priority in 2009 is to support RNs in achieving optimal outcomes for patients undergoing operative and other invasive procedures as the RN Circulator. • AORN is an association where decisions regarding the association are made by the members of the House of Delegates; including election of BOD, position statements and recommended practices. AORN Perioperative Standards and Recommended Practices Recommended Practices provide details on how things should be done in the OR based on the evidence (research). Position Statements: AORN position statements articulate the Association's official position or belief about certain perioperative nursing-related topics. Position statements are authored by an AORN Board of Directors appointees and are approved by the Board and the House of Delegates. Guidelines for practice- set best-practice standards • AORN provides education for it’s members through: Local Chapter meetings and networking State Councils (MCORN) Specialty Assemblies (for each area of practice: Ortho, OB, etc.) National meetings: Congress, Leadership and Multi-specialty Conferences AORN Journal Publication Peer Reviewed Evidence-based practice Members sharing knowledge/questions Updates in current practice Contact Hour Study Guides Editorials, book reviews, Ask the experts, etc. Tool Kits available for member use: Correct Site Fire Safety Safe medication Administration Patient Hand-off Human Factors in Healthcare PNDS: The Perioperative Nursing Data Set (PNDS) is the first of its kind: a standardized nursing vocabulary that addresses the perioperative patient experience from pre-admission until discharge. As a nursing language, PNDS is parsimonious, validated, reliable, and useful for clinical practice. To date, PNDS is the only nursing language developed by a specialty organization, the members of the Association of periOperative Registered Nurses (AORN), which has been recognized by the American Nurses Association (ANA) as a data set useful for perioperative nursing practice. RN Circulator Talking Points Website: www.aorn.org Available for members Limited access for non-members Links to all the above Public Policy Practice Resources Consultation Research Discussion Boards Career Center Access to the Journal publication and links to other research Bookstore On a side note: One of our members recently returned from a trip to Russia and Poland with a Perioperative Nursing Delegation through the People to People Citizen Ambassador Program. They met with various nurses and nursing leaders from those countries to share their knowledge and expertise. An important gift to them was a membership to AORN and a copy of the Perioperative Standards and Recommended Practices. Our goal was to help share that ‘Gold Standard” of practice. Why HB4615?: • AORN, with the support of Michigan Council of Nurses (MCORN) and COMON (Coalition of Michigan Organizations of Nurses), is championing legislation for patient safety to require that a registered nurse qualified by education, experience, and training in perioperative nursing be present as a circulating nurse throughout all operative or invasive procedures. • AORN’s objective is to work to ensure that each and every patient, regardless of setting, receives the optimal level of care possible and has a reliable advocate, the RN circulator, for their surgical needs and safety. • This is an issue, first and foremost, of patient safety. The circulating nurse serves as a patient advocate while patients are most vulnerable and least able to care for themselves. Having a RN circulator in each operating room for each surgical procedure will ensure the patient’s safety during the period of the patient’s vulnerability. • When you review the 10 top reasons for having an RN as the circulator in the OR, you realize we have the knowledge, the education, the understanding of anatomy, pharmacology, physiology, the understanding of assessment of the patient, the critical thinking skills, the ability to process everything going on and use these skills to communicate and be there for the patient for safety. RN Circulator Talking Points So why should we do this? • We are not asking for a change, not asking for more money, only reinforcing what we already do. This maintains current practice. • Our patients deserve this. We do not want to be known as a second class state in medical care in the OR. Why should Michigan have a lesser standard of care than 37 other states that have some language? • CMS language states a registered nurse should be readily available, but readily available is not good enough for our patients. • Story- what if your child and wife were in a car accident and they both needed surgery right away, but there was only one nurse over two rooms, and they both took a turn for the worse, who would they help? • We want to be proactive- let’s plan ahead. We know hospitals are continually looking at the financial package but this is about patient safety! • There may be issues in the future with the nursing shortage but this is a critical care area that can not be changed. The RN‘s job is critical in the OR; we must keep them there! • We know that surgeries are under the microscope for care given in the OR. How can we expect the best care if we do not put the best educated person in there as a circulator? • In the next year probably six other states will see this bill pass, why not Michigan? Will we be the last? There are 37 in front of us that have taken a stand for patient safety. • You cannot tell me that when your loved one is in the hospital you don’t expect the best care possible from everyone there. • Our telephone research showed 79 hospitals, 39 Ambulatory Centers and 7 unlisted centers all use RNs as Circulators routinely for patient safety. You should have heard their responses- ‘What, you have to be kidding; I thought it was a law? We wouldn’t think of using less. Of course we have an RN as the circulator. Well, yes of course!’ We look at the never events and the non-payment events and many of them can take place in the OR. • We know we are not perfect but when AORN Standards are followed and Registered Nurses are there giving the care, the errors should be less. • It has been proven that the higher trained the individual the better the care, so therefore in the long run it should be saving the hospital money because of fewer injuries and lawsuits. • We are the experts, we have the education and we know the issues. Nurses across the state are standing up for this. We have the stories to tell why this is so important and why this needs to be backed up with legislation. • If we do not stand up for ourselves, who will know what is important because what we do is behind closed doors. We are respected. You should see the look on our families faces as we take their loved ones to surgery, you should see the look on our patient’s faces as the way they hold our hands as they drift off to sleep. • They give up their control and trust us to give them our best care • We started this over 3 years ago when our idea was submitted to bill writers. We spent 6- 8 months trying to get someone to sponsor it; waiting for responses back from legislators. We waited as budget issues were being hotly contested and as vacations and summer recess was taken. We deserve to move this forward. We had a successful Lobby day RN Circulator Talking Points where nurses that you do not usually hear from, stood proud and determined to get this bill passed. • We want to come from behind the mask and from behind the closed doors and stand up for what is right and for our patients; our patients are expecting when they go to the OR, that they are getting the best care possible. We now hope you understand better about a silent and little seen, but very critical, job of patient safety. • Times are a changing- technology is increasing and the acuity of our patients is increasing as people age and live longer. • We want to be proud of Michigan as you stand with us and pass legislation to protect our patients by always providing an RN as the circulator. Conclusion: AORN is actively promoting this legislation on the state level and we are seeking support from you to ensure that the supervisory presence of the professional registered nurse is present in the operating rooms and the ambulatory surgical centers of MI during the entire surgical procedure. HB4615 ensures that the registered nurse will be the circulating nurse in all operating rooms and ambulatory surgical centers thereby ensuring the patient safety of your constituents. It is our hope that you will pass this important legislation for the state of Michigan.