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

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

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.geocities.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

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

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, itÌs 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 ÔThe 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. YouÌll 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 donÌt 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! ThereÌs 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 membersÌ voting records public. This will become more important if Ôone 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 arenÌt 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. TheyÌd 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 managersÌ wages rose 21%. Those of a pharmacy director rose 20%.

* The treasurerÌs report was surprising. Due to the low Dallas Congress attendance, ORNCC lost $824.03 at the Congress luncheon. ThereÌs 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

ThereÌs 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 didnÌt 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 candidatesÌ speeches will be permitted at the Congress luncheon this year (there were many candidatesÌ speeches at Congress 2000 which took many of us by surprise).

TreasurerÌs 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 wasnÌt 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). ItÌs 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 Ôno 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 youÌre 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, wasnÌt 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 (itÌs 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 chapterÌs 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 (thatÌs 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. ItÌs 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, ÔNursing: 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 (ÔWhat 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. ThatÌs 9%. San Diego has 350 with 30-40 people attending meetings. ThatÌs 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 (ThatÌs a sentiment I disagree with wholeheartedly!).

ThereÌs 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!). ItÌs taken over one year to develop this revision.

The ÔrescueE 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 Ôdues-apnicE chapter (translated means we hadnÌt 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 ÔManaging 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 wonÌt 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! SheÌs 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 thatÌs 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 ÔrescueE 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 donÌt have long term relationships but one positive is RNs now have a chance because new legislators donÌt 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 Ônurse.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 doesnÌt 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. ItÌs 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 Ôdues-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 donÌt see you at the December meeting, hope you have ÔHappy Holidays!E


Submitted by Pam Reuling

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

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

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.

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