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RN Circulator Talking Points

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					                              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
                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
  • 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
                           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
•   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
                   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

                     Available for members
                     Limited access for non-members
                     Links to all the above
                     Public Policy
                     Practice Resources
                     Discussion Boards
                     Career Center
                     Access to the Journal publication and links to other research

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
  • 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
  • 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.

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.