ANA spots concerns in new version of Medicare regs

News may be good for operating room nurses in the new proposed Medicare regu- lations issued Jan 4, but the American Nurses’ Association (ANA) believes that nursing as a whole did not fare as well. The latest version states that the circulator in the operating room must be a registered nurse, which AORN regards as a victory. (See editorial in the February Journal.)

ANA has expressed concern that other sections of the regs “could lead to substand- ard care in some hospitals and could subject beneficiaries to second-class health care.” ANA made its objections known when a pre- liminary draft was circulated last summer. The organization was analyzing the Jan 4 draft and preparing further comments for the government’s March 7 deadline.

The latest version addresses one of ANA’s concerns-that the director of nursing must be a registered nurse. The preliminary copy had not so specified.

Three other major issues were: 0 All references to orientation and staff

development have been deleted, except for infection control. ANA said it believes this is “short sighted” in view of the federal govern- ment’s support for technological innovation.

ANA asked, “Without staff development programs, how can the patient be assured that the nursing staff will know which button to push, which tube to connect or disconnect, what changes in vital signs to expect, and what chemical interactions to be alert for?”

3 Legislation

0 RNs would have more types of unli- censed personnel to supervise. Medication technicians are sanctioned, for example. “The requirement for RN supervision does not make this a safe practice,” ANA states, be- cause RN staffing may be so low that proper oversight is impossible. In addition, the tech- nicians would not have the proper back- ground to monitor drug reactions and inter- actions and intravenous infusions.

0 The standard for nurse staffing is inade- quate. The proposed standard states:

The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit toensure, when needed, the immediate availability of a reg- istered nurse for bedside care of any patient. There must be a registered nurse on duty at all times and available for all patients on ii 24-hour basis. ANA has some concern that the standard is

not as explicit as the current language, Rose Boroch, RN, of the Washington ANA office explained.

The rules, under revision since 1977, per- tain to hospitals participating in the Medicare and Medicaid programs. In effect, they apply only to hospitals not accredited by the Joint Commission on Accreditation of Hospitals, because its standards are accepted in lieu of the government regs.

AORN has been battling for five years to have only the RN as circulator. A draft pub- lished in 1980 would have permitted the operating room technician or licensed prac- tical (vocational) nurse to circulate. Operat-

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ing room nurses flooded the Health Care Financing Administration with letters and the Association submitted an extensive brief.

Although AORN finds the revised language satisfactory, it was monitoring responsesfrom other groups in case more letters were needed.

The AORN Board of Directors has ap- proved hiring a legislative monitor in Wash- ington, DC. The person will be assigned to keep the Association informed of federal leg- islation and regulations that are of interest and concern. The Board emphasizes that the monitor will not be involved in lobbying. Can- didates for the position are being interviewed by the AORN staff.

The ANA is studying how government budget cuts are affecting care for mothers and infants. Plans are to have results ready before the 1984 election, the American Nurse reports.

Volunteer nurses will gather data from selected hospitals and pregnant women who receive government aid. The study will cover four states and the District of Columbia. States participating are Delaware, New Jer- sey, New York, and Pennsylvania.

Nurses won “a major victory” with the Senate’s defeat in December of an amend- ment that would have prevented the Federal Trade Commission (FTC) from overseeing the professions, said Thomas Nickels, ANA legislative counsel. The Senate refused to add the amendment sponsored by Sen James McClure (R-Idaho) to the continuing resolu- tion that will fund the commission through Sept 30. The issue may surface again when Congress considers a new funding bill.

The major role of the FTC is to ensure free and fair competition in interstate commerce. If the FTC has jurisdiction over the profes- sions, nurses may have moreclout when they believe they are prevented from competing for patients. For example, two Tennessee nurse midwives contend they were illegally denied hospital privileges by three hospitals and four physicians. They have filed a lawsuit.

Traditionally, professions have been ex- empt from FTC oversight. Recently, Supreme Court decisions have indicated professions should be covered. In one case, the Court

ruled last spring that physicians could adver- tise without interference from their medical associations. Some groups, notably the Amer- ican Medical Association, sought the McClure amendment to keep professions exempt. ANA opposed them.

ANA has a new director of government relations in its Washington office. Deborah Smith, RN, assumed the position Jan 3.

Formerly, she was associate administrator of government relations with the Illinois Nurses’ Association. She served as chief lobbyist in thespringfield, 111, office, dealing with legisla- tion relating to health, nursing, labor., and women’s issues.

Smith has also been a legislative aide to former Sen Adlai Stevenson (D-lll)and a con- sultant to the Nurses’ Coalition for Action in Politics, the ANA political arm. She received a BSN from Montana State University School of Nursing, Bozeman.

AORN members will remember her as a speaker at the 1980 legislative seminar held in Chicago.

Patricia Patterson Associate editor

NL N names acting director The National League for Nursing (NLN) has named former Deputy Director for Program Affairs Mary F Liston, RN, EdD, as its acting executive director. She replaces Margaret E Walsh who resigned as executive director Dec 31, 1982.

1978. Previously, she was a professor at The Catholic University of America School of Nursing, Washington, DC. She has served as NLN’s vice-president. A graduate of St Vincent’s Hospital School of Nursing, New York City, Liston has a BS degree from the College of Mount St Vincent, New York City, a MSNEd from The Catholic University of America, and an EdD from Columbia University, Teachers College, New York City.

Liston has been the deputy director since

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