AORN JOURNAL MARCH 1984, VOL 39, NO 4

Legislation Nursing institute proposal passes

0 In January, it was the US Senate’s turn to consider a proposal establishing a new National Institute of Nursing. Located within the National Institutes of Health (NIH), the institute would promote nursing research.

The US House approved the institute in November in an amendment to a bill reauthoriz- ing spending for the NIH.

The speed of its House passage “took people by surprise, ” said the well-known journal Sci- ence (Dec 23) . Why did approval come so quickly?

Nurses’ growing political strength might be part of the reason.

“Capitol Hill staffers report that nurses are more dedicated voters than many groups,’’ the Science report said. An estimated 1 in 40 voters is a nurse.

“Many are thought to vote Republican. Most are women,” the report continued.

Republican legislators might have seen the institute as a way to bridge the “gender gap. ” The term describes what some believe is a loss of support for the Reagan administration by women. The institute proposal was introduced by Rep Edward Madigan (R-Ill).

Another boost for the Institute was the nursing study completed last year by the prestigious In- stitute of Medicine, in which such an agency was recommended. Working against the measure was the fact that “it is hard to pin nursing re- search down in a way that makes it obvious that it belongs at NIH,” Science said. NIH officials were opposed to the institute, as they have been to other new institutes. The White House also

said it opposed creating new institutes. What the Senate will do is unknown. A dis-

pute over fetal research was holding up its own NIH bill. The Senate might vote on the House- passed bill or send it to a committee for further consideration.

0 Missouri nurses had their day in court and won.

The state supreme court ruled they were not practicing medicine when they performed pelvic examinations and administered oral contracep- tives, intrauterine devices, and vaginal medica- tions.

The ruling overturned a lower court decision in which the judge said, “Graduation from a school of medicine is a prerequisite for one to be capable of interpreting the results of a pelvic examination. ” His opinion sent a tremor around the country among nurses practicing in the ex- panded role. (See April 1983 Journal, pp 814- 816.)

The case started when the Cape Girardeau Medical Society complained that nurses and physicians at the Eastern Missouri Action Agency, a federally funded family planning and abortion clinic, were violating state law by prac- ticing medicine. Nurses Janis Burgess and Suzanne Solari were taking histories, doing breast and pelvic exams, performing lab tests such as Pap smears, providing contraceptives, administering medications, and counseling and teaching. These were all done under standing orders and protocols. No one charged that the nurses had done any harm to patients. No one

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AORN JOURNAL MARCH 1984, VOL 39, NO 4

questioned their education and skill. When the State Board of Registration for the

Healing Arts decided to take action against them, the nurses and their supervising physicians went to court. After losing at the local level, they appealed to the supreme court.

The high court focused on the issues of the pelvic examinations and providing contracep- tives and medications. The justices found the activities consistent with the state legislature’s intent to expand nursing practice when it passed a revised nursing practice act in 1975.

Under the act, the court ruled “a nurse may be permitted to assume responsibilities heretofore not considered to be within the field of profes- sional nursing so long as those responsibilities are consistent with her or his ‘specialized educa- tion, judgment and skill based on knowledge and application of principles derived from the biolog- ical, physical, social and nursing sciences. ’ ”

The court continued: “Physician prepared standing orders and protocols for nurses and other paramedical personnel were so well estab- lished and accepted at the time of the adoption of the statute that the legislature could not have been unaware of the use of such practices. We see nothing in the statute purporting to limit or restrict their continued use. ”

0 The government published final rules for Medicare prospective reimbursement in the Jan 3 Federal Register. Included are all the stipula- tions for use of diagnosis related groups (DRGs). The first hospitals began using this new payment system in October 1983.

The regulations are generally the same as interim regulations published Sept 1. (See November 1983 Journal, pp 842-843). Among the changes were a slight reduction in the infla- tion factor for DRG rates and a new method of figuring outlier payments. (Outliers are atypical cases that have extremely short or long lengths of stay compared to other cases in a DRG.)

Association (ANA) provides an up-to-date pic- turc of direct reimbursement. Entitled Third- Party Reimbursement for Services of Nurses, the booklet is available from ANA, 2420 Pershing Rd, Kansas City, Mo 64108. It is part of a series entitled Economic and Employment Issues for Registered Nurses.

PATRICIA PATTERSON LEGISLATIVE CONSULTANT

Legislation Seminar to Be Held Washington in the spring. What a good place to combine a learning experience with a vacation. AORN is sponsoring “Politics and Your Practice,” a seminar on legislation, May 5 , in the capital city.

Learn about practical aspects of the legislative process with Joanne Symons. As director of political education for the American Nurses’ Association, she has an experienced view of how nurses can be effective in the political arena.

A second speaker, to be announced later, will be knowledgeable about policy issues important to your practice, such as Medicare’s new prospective reimbursement system.

For registration information, write or call the AORN Education Department, 10170 E Mississippi Ave, Denver, Colo 80231. Phone 303/755-6300.

[7 Nurses are making steady progress in gain- ing third-party payments from insurance com- panies and the government.

A new publication by the American Nurses’

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