Protect your future: Get out a stamp, write to Washington There is something you can do for your profes- sion and your specialty of operating room nurs- ing.

At Congress, the Superior Chapter of North- ern California proposed that each AORN member write to his or her congressman, senator, and the US Department of Health, Education, and Welfare (HEW) urging preser- vation of the sections in the Medicare regu- lations that specify that a registered nurse supervise the operating room service and that the operating room technician “may assist in circulating duties under the direct supervision of a registered nurse.”

We think this is a good idea and one the whole membership should hear. In his keynote address at Congress, Sen Daniel K lnouye (D-Hawaii) told the audience that individual letters from nurses were much more effective than a letter from the president of an associa- tion. He encouraged nurses to “take the time and a 13-cent stamp” to write to legislators individually rather than collectively through their organization.

When it was first known that HEW was con- sidering changes in the Medicare regulations that might affect operating room nurses, AORN wrote to each congressman and senator as well as HEW. After the workshop meeting last November, AORN sent its re- sponse to HEW.’

The response emphasized the role of the registered nurse as supervisor and circulator. In the proposed HEW revisions, it is stated that

Editorial rd “qualified operating room technicians and licensed practical (vocational) nurses may be permitted to perform scrub or assist in circulat- ing duties under the direct supervision of a registered nurse who is readily available to respond to emergencies.” AORN asked the deletion of the phrase “who is readily available to respond in emergencies” because it be- lieves that the technician who is assisting in circulating duties should be under the direct supervision of the registered nurse.

Both the American College of Surgeons (ACS) and the American Nurses’ Association (ANA) have supported AORN’s position. In a letter to HEW, C Rollins Hanlon, MD, ACS executive director, wrote: “The individual in charge of the operating room during a vital part of the treatment should be a professional regis- tered nurse with an educational background commensurate with the important respon- sibilities involved.” He also urged retention of the section specifying that the operating room service and related facilities be supervised by a registered nurse and that technicians assist in circulating duties only under the direct supervision of the registered nurse. At the clos- ing session of Congress, outgoing President Nancy Ertl read a telegram from ANA stating: “The American Nurses’ Association supports the recommendations submitted by the Asso- ciation of Operating Room Nurses for changes regarding draft specifications proposed by HEW for operating rooms.” AORN has also supported the ANA recommendation regard- ing the revised regulations.

Why is the government considering chang- ing these regulations? In a letter to AORN Executive Director Jerry Peers, Jerry Shein- bach, acting assistant administrator, Office of Standards and Certification, Health Care

AORN Journal, June 1978, Vol 27, No 7 1269

Financing Administration, HEW, stated that the overall changes are "designed to allow a hospital greater flexibility in the utilization of its staff, equipment, and iacilities." The Medicare regulations are in addition to Joint Commission on Accreditation of Hospitals standards and are primarily directed toward unaccredited hospitals, but are binding on all institutions. More specifically, the changes relating to operating room nurses seem to be prompted by difficulties of smaller, rural hospitals in sec- uring qualified registered nurses as well as pressure from groups representing techni- cians and licensed practical and vocational nurses. These groups contend that techni- cians and LPNs are supervising and circulat- ing and have the ability to perform these func- tions.' Although the proposed revisions do state that the registered professional nurse supervise the operating room service, these groups are pressuring to have that changed.

HEW officials have expressed the belief that performance and experience are more mean- ingful to the provision of acceptable patient care than educational standards. Note the use of the term "acceptable patient care." In an article in the Congress News, President Jean Davis commented that "what was once viewed as 'highest quality care' is now referred to as 'acceptable patient care.' "

Now it is your turn, as working operating room nurses, to reinforce and amplify the ef- forts of AORN, ACS, and ANA by letting your legislators and HEW officials know that these regulations are important to you and patients in the operating room. -

in writing to your legislators and HEW, refer to Medicare Conditions of Participation for Hospitals (CFR 20, Regulation No 5, subpart J). Urge that section 405.1023(a)(l) be pre- served unchanged. It states: "The operating room service and related facilities are super- vised by a registered nurse." Section 405.1023(a)(2) should also be preserved un- changed. It reads, "The operating room tech- nician may assist in circulating duties under the direct supervision of a registered nurse."

Write directly to your own legislators, ad- dressing them by name. You can write to Jerry Sheinbach, Acting Assistant Administrator, Of- fice of Standards and Certification, Health Care Financing Administration, 330 C St SW, Washington, DC 20201. In your letter, include

your own name and address. Explain that you are writing about possible revisions to the cur- rent Medicare regulations that will affect nurses as well as patient care in the Operating room. Support your position with concise statements and say why you think this is impor- tant in terms of health care. Letters should be brief as well as courteous. Ten individual let- ters from chapter members will have more weight than a lengthy letter from the whole chapter.

Think what might happen if 26,000 operating room nurses write to Washington to say, "We believe it is important that the supervisor of the operating room be a professional registered nurse." Think what might happen if 26,000 operating room nurses write and say, "It is important that the circulator in the operating room be a professional registered nurse."

Our government is based on responsive- ness to public demand. Unfortunately, some- times the voices that are heard are those that are best organized or best financed. But there is no reason why operating room nurses can't make themselves heard and their interest known through the use of something as simple as a pen, a sheet of paper, and a S c e n t stamp. I 5

Hinor S Schrader Editor

Notes 1. "AORN's response to HEW'S proposed Medi-

care revisions," AORN Journal 27 (April 1978) 813- 814.

2. Nancy Ertl, "HEW considers Medicare revi- sions re OR circulator," AORN Journal 27 (March 1978) 605-606.

Omission In the March Journal, the article by Mabel Crawford, RN, "Unique job eases retirement," was omitted from the table of contents. The article relates the author's experiences indexing current nursing literature.

AORN Journal, June 1978, Vol27, No 7 1271