AORN Surgical Conference & Expo Business Sessions
he 3,428 authorized delegates to the 61st annual AORN Congress voted to rescind the process change that was adopted in 2013 for approving position statements. They also charged the Board of Directors with tasking a Bylaws Committee to bring a solution to the 2015 House of Delegates to ensure that the delegates’ voices are heard in approving AORN position statements. Because of a bylaws change, the number of authorized delegates more than doubled this year, up from 1,348 in 2013. Delegates at the first Forum and the second session of the House of Delegates heard reports on the state of the association and its subsidiaries. During the first Forum, members learned about the AORN approval process for position statements and the 2013 member needs assessment. The six position statements ready for member approval were presented at the first and second sessions of the Forum. During the second Forum, delegates heard about revisions to AORN documents for RN first assistants (RNFAs), a report from the Governance Strategic Task Force, and the new Quality and Safety Education for Nurses
AORN President Rosemarie Schroeder and Amy Hader address attendees at the first Forum to discuss the approval process for position statements.
(QSEN) initiatives. During both Forum sessions, delegates were given the opportunity to discuss clinical practice issues. During the second session of the House of Delegates, attendees voted on six position statements that were up for approval. The newly elected members of the Nominating and Leadership Development Committee, members of the Board of Directors, and officers were announced at the end of the second session of the House of Delegates. AORN POSITION STATEMENTS Six position statements were on the agenda for approval in 2014. Delegates first discussed the pros and cons of the current approval process for position statements, which was changed at the 2013 House of Delegates to require approval by the members. The information presented here encompasses discussion and actions related to the position statements during both Forum sessions and both sessions of the House of Delegates. Adoption of the motion to change the process for position statement approval, and to approve each position statement, required a majority vote. During the first session of the House of Delegates, votes were held by a show of hands; in the second session of the House of Delegates, electronic voting methods were used. Approval Process The process change in 2013 led to unintended consequences, and AORN was unable to share its positions on several topics with other associations, including the American College of Surgeons, the Council on Surgical and Perioperative Safety, the American Nurses Association, and a coalition of health care industry representatives. Amy Hader, AORN’s legal counsel and director of Government Affairs, discussed the process for approving AORN position statements. http://dx.doi.org/10.1016/j.aorn.2014.04.004
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Ó AORN, Inc, 2014
AORN CONFERENCE BUSINESS SESSIONS The resolution that was adopted by the 2013 House of Delegates “elevated the approval of position statements to a member action, requiring either a meeting or unanimous written consent under New York’s not-for-profit corporation law,” Hader explained. That is, to approve a position statement at any time other than during the annual meeting would require either written approval from all AORN members or a special meeting, which under AORN’s current bylaws would require a quorum totaling the number of delegates from the immediately preceding House of Delegates. For 2013, that number of delegates was 1,348. The Board of Directors and executive team at AORN explored ways to accommodate a special meeting for six position statements that were developed between 2013 and 2014, and none were feasible without a bylaws change. “It was very difficult for us to not give a stance on the issues,” said AORN President Rosemarie T. Schroeder, BSN, RN, CNOR. “We had the information in development but wanted to respect the members’ decision to not have these out there until they are approved.” Delegates expressed concerns about changing the process and potentially losing the members’ voice in AORN position statements, while others felt the Board of Directors should be trusted to represent the membership. One delegate urged the Board to “look at ways to include the House in decision making, allow us to have a say, and allow us to feel like we’re governing our profession.” Another noted, “If we elect you, the Board, to represent us, we need to do that in good faith and use the opportunity to make our comments online . . . so that we have collective input from all of us.” One suggestion from the floor was to conduct meetings electronically, but even electronic meetings are subject to the large quorum requirement in the current bylaws. “The constraints with the large quorum is not the technology required for that size of meeting, but [AORN’s] ability to get that many people” to call in a special meeting, said Lola Fehr, MS, RN, CAE, RP, FAAN, AORN
AORN Parliamentarian Lola Fehr provides guidance to the delegates about changing the approval process for AORN position statements.
parliamentarian, citing low participation in town hall meetings and webinars as a rationale for why this would be unlikely to work. “The restriction comes in voting to take official action,” she added. “We can do as many informational meetings as our technology will accommodate, but the voting process is where we run into unintended barriers in the motion adopted last year.” Fehr presented three possible solutionsdwhich were not necessarily mutually exclusivedto the delegates: n
Rescind the motion adopted at the 2013 House of Delegates. n Amend the bylaws to change the quorum required for a special meeting. n Amend the Articles of Incorporation to override the default provisions in the New York not-for-profit corporation law under which AORN is incorporated. During the second session of the House of Delegates, William J. Duffy, RN, MJ, CNOR, FAAN, brought a motion before the delegates that the Board of Directors charge the Bylaws Committee with bringing a bylaws amendment to the 2015 House of Delegates that would establish a quorum for special meetings, including setting a minimum number for the quorum and the diversity of representation of the membership. When brought to a AORN Journal j 705
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William Duffy proposes a motion that a Bylaws Committee be charged with bringing a bylaws amendment to the 2015 House of Delegates to establish a quorum for special meetings.
vote, the motion passed. Billie Fernsebner, MSN, RN, made a motion to rescind until the 2015 House of Delegates the motion that was adopted in 2013. When put to a vote, the motion passed. Position Statements Six AORN position statements underwent public comment and revision in 2013e2014. Each was presented to the delegates for discussion before they were put to a vote for approval. A motion was made and approved to amend the AORN Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment to strike the words “as authorized by the state regulatory body” from the first bullet point under “Definition of a perioperative APRN” and add the words “as authorized by applicable regulatory bodies” after the word “who” in line one of that section, so that the lines read as follows: The perioperative APRN is a nurse who, as authorized by applicable regulatory bodies, n
practices in the preoperative and postoperative areas . . .
When put to a vote, the amended position statement was approved. There was no discussion on the other five position statements. When put to a vote, each was approved: 706 j AORN Journal
AORN Position Statement on One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure AORN Position Statement on Perioperative Safe Staffing and On-Call Practices AORN Position Statement on Environmental Responsibility AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care AORN Position Statement on the Role of the Health Care Industry Representative in Perioperative and Invasive Procedure Settings
To assist delegates in planning for the coming year, President Schroeder announced that four position statements are scheduled to undergo revision and public comment in 2014e2015: n
AORN Position Statement on Key Components of a Healthy Perioperative Work Environment n AORN Position Statement on Perioperative Care of Patients With Do-Not-Resuscitate or Allow-Natural-Death Orders n AORN Position Statement on Care of the Older Adult in Perioperative Settings n AORN Position Statement on Entry into Practice These statements will be posted online for review and comments before they are revised. Final, approved position statements are posted to the AORN web site at http://www.aorn.org/Clinical_Practice/ Position_Statements/Position_Statements.aspx. OTHER BUSINESS Delegates heard results from the 2013 AORN membership needs assessment at the first Forum. At the second Forum, they heard a report from the Governance Strategic Task Force about modifying AORN’s governance structure and learned about revised AORN documents for RNFAs. For the first time this year, attendees at both Forum sessions were given the opportunity to bring clinical practice issues up for discussion.
AORN CONFERENCE BUSINESS SESSIONS Membership Needs Assessment Results from the 2013 membership needs assessment survey have clarified what AORN members need the most help with, according to AORN Marketing Director Brian Tepp. One result that came through loud and clear was that the AORN web site needs updating to be more user friendly. Other results included that members’ number one need is help with implementing the recommended practicesda similar theme to the 2010 surveyd and 80% of respondents said they want “quick tips” that they can use in practice. Tepp identified several initiatives planned for the year to address member needs, “improve the value proposition,” and keep AORN relevant. With support from the AORN Board of Directors, internal teams will be created to develop new recommended practices implementation tools, expand the collection of policies and competency documents and create staff training and reference guides, and evaluate and improve the AORN web site and online education process. Delegates responded to the news by saying that members’ voices must be included in the discussion. Tepp assured the audience that AORN members, as well as nonmembers and lapsed members, will be included in the new initiatives to help ensure that any new products or services will satisfy perioperative nurses’ needs and potentially help expand membership. Governance Strategic Task Force Susan K. Banschbach, MSN, RN, CNOR, chair of the Governance Strategic Task Force, noted that because there is significant competition among professional associations, the task force reviewed strategies for remaining relevant and developed recommendations for AORN. The task force initiatives were to make recommendations for restructure of the composition of the AORN Board, if deemed appropriate, and to evaluate the structure of the House of Delegates annual meeting for nimbleness in decision making.
The Task Force members recommended keeping a 12-member Board of Directors but changing the composition slightly. They proposed keeping the elected offices of President, President-elect, and Treasurer as well as seven elected members of the Board. They recommended the following changes: n
eliminate the office of Vice President and move the responsibilities to the President-elect, n appoint a consumer member (nonvoting), n appoint an intern (nonvoting) to represent younger members, and n eliminate the office of Secretary and instead appoint one of the elected Board members to serve in that role. The second recommendation from the task force was that “the House of Delegates annual meeting structure remain intact and the membership [be] given an opportunity at one of the virtual town halls and one of the Forums to discuss their needs and recommendation of the content of the annual business meeting.” The third recommendation was that “the Board actively market to and encourage Chapter Presidents to have the membership discuss their views on the structure and content for the annual business meetings and Forums,” Banschbach said. “And, if attending Congress, to actively represent the Chapter’s needs during the Forum presentation.” During discussion, Banschbach confirmed that the recommendations from the task force will need to be discussed by the incoming Board members and presented to a Bylaws Committee to discuss. One speaker from the floor requested that the recommendations from the task force be provided to the delegates. Another delegate agreed, saying, “We need to hear from members what they think the bylaws should look like. And because this is such a comprehensive change, figuring out how this change over here affects that change over there will take a fair amount of digesting.” President Schroeder announced that the information would be posted on the AORN web site. The issue was called for time.
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AORN Content Changes for RNFAs Barbara Firlit, BS, RN, CNOR, CRNFA, presented changes made to the RN First Assistant Standards of Practice, and Heidi Nanavati, MSN, CRNP, CNOR, presented changes made to the AORN Standards for RN First Assistant Education Programs. Changes were made to align all of AORN’s RNFA-related documents so as to provide consistent guidance to RNFAs. There was no discussion. Firlit noted that there were a few content changes to the RN First Assistant Standards of Practice, including added content on fire safety, the time out, and the brief or huddle. Additional changes were made to the formatting to align with the AORN “Standards of perioperative nursing practice.” Two key changes were made to the AORN Standards for RN First Assistant Education Programs, Nanavati said. The first was the description of the requirements for the length of the program, from one academic year to a minimum of the equivalent of six semester credit hours of formal, post-basic RN education. The second change was to accommodate the APRN who is entering an RNFA program, with emphasis on the APRN without OR experience. The main change was in the summarization of the content the APRN should complete if he or she is not proficient in the needed skills at the beginning of the program. The list
Heidi Nanavati explains changes to the AORN Standards for RN First Assistant Education Programs.
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AORN CONFERENCE BUSINESS SESSIONS of content is a summary of the AORN Periop 101Ò program. Clinical Practice Issues A new agenda item for the Forum sessions was “Clinical Practice Issues.” The intent, President Schroeder explained, was to give the delegates a forum in which to discuss clinical practice and receive input. During the discussion, delegates asked questions about office-based practice guidelines, increasing membership by marketing AORN standards based on consideration of patient needs, and legislative activity around obstetrical practice. Suggestions from the floor included considering whether AORN needs a recommended practices document or position statement n
to guide the use of wearable devices in the OR and n on mentorship and succession planning and whether task forces be formed to n
offer guidance on the changing patient-centered environment (eg, having family members in the OR for donation after cardiac death, during induction of anesthesia), n improve patient safety for mothers during cesarean deliveries, and n address competencies for robotic surgery. One delegate asked where implementation of the AORN recommended practices should begin. “We have not given a systematic analysis of where other invasive procedures are occurring and how application of our [recommended practices] and standards should occur,” he said. “That’s concerning as we see hybrid ORs coming into most of our ORs and the clashing of standards from the radiology association and others. I would request that we have to have a really thorough plan to help people understand how to implement the standards to provide the safest environment for patients, but it has to be evidence based.” Another delegate asked about AORN’s collaboration with the Institute for Healthcare Improvement
AORN CONFERENCE BUSINESS SESSIONS (IHI) to create educational resources. AORN Executive Director and Chief Executive Officer Linda K. Groah, MSN, RN, CNOR, NEA-BC, FAAN, addressed the question, saying AORN has collaborated with IHI on a number of occasions, including that AORN Past President Charlotte Guglielmi, MA, BSN, RN, CNOR, has served on an IHI surgical advisory committee for the past two years and the organization has renewed interest in partnering with AORN. One potential synergy that Groah pointed out is IHI’s content specific to perioperative practice, which could be integrated into the AORN SyntegrityÒ Perioperative Documentation Solution. When the format of the AORN business sessions came up for discussion, several people voiced the importance of these sessions for ensuring that the delegates are heard. One delegate noted that the roll call took 35 minutes, leaving only 25 minutes for discussion at the first session of the House of Delegates. Another member said that although the roll call “was interesting . . . it was lengthy,” and she proposed creating a template to streamline the process. Another suggestion was made to move the Forums to occur earlier in the day as well as extend them to provide sufficient time for discussion. President Schroeder explained that although a second Forum was added to the schedule in 2014 specifically to provide time for discussion, the input about the time allotted for the House of Delegates will be considered. Another suggestion was made to publish the reports that are presented during the business sessions electronically in advance and then provide time for the delegates to ask questions. This has potential to work, President Schroeder said, because AORN’s governance documents do not require that the reports be presented in person. QSEN “Do you speak QSEN?” asked Susan D. Root, MSN, RN, CNOR, manager of perioperative education at AORN. During her presentation, Root explained how QSEN is being used in nursing curricula and how AORN is using it.
Attendees at the first session of the House of Delegates applaud the good news presented during the Treasurer’s Report.
The QSEN initiative began in response to the Institute of Medicine report, The Future of Nursing, to focus on RN education and six core competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. “Mastery of these competencies is essential for RNs to improve both patient care delivery and health care environments.” Root said. For QSEN to be successful, Root said, new strategies for education are needed. “You can find excellent teaching strategies and resources on the QSEN web site” at http://www.qsen.org, she added. “Because of AORN’s commitment to promoting the use of the perioperative environment for clinical experiences, we felt that linking AORN course content to QSEN competencies would demonstrate that close connection,” Root said. AORN has incorporated QSEN into its Fundamentals of Perioperative Practice Course. Next steps are to incorporate graduate-level competencies into all of the Periop 101 modules and then incorporate QSEN into all of AORN’s other education and competency tools. REPORT HIGHLIGHTS During the first session of the House of Delegates, attendees heard reports from the AORN Treasurer, President, and Chief Executive Officer. The remaining AORN Journal j 709
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three reports on the agenda were moved to the second session of the House of Delegates because time was called and the delegates voted down a motion to extend the time. At the second session of the House of Delegates, attendees heard these remaining reports from AORN Works, the Nominating and Leadership Development Committee (NLDC), and AORN Foundation. Treasurer’s Report Financially, AORN, Inc, and its subsidiaries had “terrific results” in 2013, said Treasurer Martha D. Stratton, MSN, MHSA, RN, CNOR, NEA-BC. AORN Works, a wholly owned for-profit subsidiary of AORN that offers interim placement services for nurse managers, reported profits of $37,000 for the year, despite initial projections for a $25,000 loss. The positive result was attributed to additional marketing efforts implemented midyear. The AORN Foundation, the philanthropic arm of AORN that raises funds to provide scholarships and education and research grants for perioperative nurses, had a record year with more than $2.7 million in revenues. The $623,000 growth over 2012 was attributed to a large and unexpected grant from industry and the Nurse Executive grants pledged in 2013. AORN, Inc, also posted a record year with revenues of nearly $21.2 million, 3.4% above 2012 revenues. The positive year was attributed to increased sales of Periop 101, new face-to-face events, increased AORN Journal advertising, increased purchases of AORN Journal continuing education, and increased sales of the Perioperative Standards and Recommended Practices. Net income came in at $0.87 million, offset by higher expenses in 2013 compared with 2012. AORN expenses for 2013 were $20.8 million compared with just less than $20.1 million in 2012 and are expected to increase again in 2014. Because of this, AORN is projecting a modest net income of approximately $117,000 for 2014. Expenses in 2014 include additional compensation allocated for new employees needed to help 710 j AORN Journal
AORN CONFERENCE BUSINESS SESSIONS ensure the success of several initiatives, including improving the AORN web site and adding to the collection of recommended practices implementation tools. These initiatives and others are based on the results of the 2013 membership needs assessment. Officer’s Report “We have listened, and we have heard you,” President Schroeder said. She discussed the membership needs assessment and the plans for AORN based on the results. Key issues include redesigning the web site, ensuring easily navigable mobile access to free education, and reducing costs and time demands for AORN membership and meetings. “Your Board has responded by allocating resources to addressing these identified needs, including significant financial support that has been allocated to [information technology] to address technological upgrades and making our web site user friendly,” President Schroeder said. The association’s increased focus on clinical resources includes adding implementation tools for the evidence-rated recommended practices, production of which has been “stepped up”; launching online Perioperative Action Bundles for the prevention of retained surgical items and wrong site/ side surgery; expanding resources for ambulatory surgery centers, interventional radiology suites, and
AORN President Rosemarie Schroeder gives the Officer’s Report during the first session of the House of Delegates.
AORN CONFERENCE BUSINESS SESSIONS procedural and office-based settings; and adding content to the AORN Journal, including the “Crisis Considerations” column and the “Back to Basics” series. Also regarding the AORN Journal, President Schroeder announced that AORN has partnered with Elsevier to translate the AORN Journal into Chinese in 2014, which elicited a round of applause from the audience. Executive Director’s Report The web site improvement project will incorporate input from members and nonmembers, health care organizations, and industry partners, Groah said. She stressed that involving perioperative nurses in the planning for AORN initiatives is key to ensuring that the outcomes meet member needs and help expand membership. Groah also announced that in response to member needs, the eBook app for the Perioperative Standards and Recommended Practices will be available this year, news that the attendees applauded. She also shared ways in which AORN has involved members in shaping the direction for AORN, including holding focus groups at the AORN Surgical Conference & Expo to garner feedback on redesigning the AORN Journal, soliciting member feedback to update and improve Periop 101 courses specific to ambulatory and obstetrical nurses, establishing an Ambulatory Surgery Division and the Center for Nursing Leadership, and implementing the 2013 launch of version 2.0 of AORN Syntegrity. “In 2014,” Groah said, “we envision an organization and profession that, in the middle of change and transition, stands respected, resourceful, and relevant.” AORN Works Report The current US economy led to an “alarming trend” in the financial standings for AORN Works, said Susan K. Banschbach, MSN, RN, CNOR, President of the AORN Works Board. To address this trend midyear in 2013, the Board approved funding to increase marketing efforts and work on rebranding to help increase awareness. The efforts included
creating new logos, messaging, marketing materials, and advertisements; sending targeted mailings; enhancing the web site (http://www.aornworks .org) and improving search engine optimization; and designing a new exhibit booth. The efforts paid off, and AORN Works ended the year with a profit. “For 2014, we’re encouraged because of the strong half of 2013,” Banschbach said, especially in light of current questions about how accountable care organizations and the Affordable Care Act will affect health care. “Continued investment in marketing is important,” she added. “We need to get creative because hospitals will be choosy about how they spend their money.” NLDC Report For the 2013e2014 ballot, the NLDC received 136 nominations, 126 of whom were eligible to run. Thirty-four people submitted applications, representing a 60% increase over 2012, noted NLDC Chair Kelly Kollar, MSN, RN, CNOR. Of those, 21 names were placed on the ballot. Kollar noted that although she could not share details from the deliberations, she wanted to explain that the reason why there was only one candidate running for the office of President-Elect is because the other people who were offered the option to run declined. In addition to setting the ballot for the year, the NLDC members worked on a virtual town hall about nominations by petition and two webinars: “Becoming InvolveddTaking it Nationally” and “The AORN Candidate Process & Experience.” They also added “a new facet to the election process” by uploading introductory candidate videos to the web site along with candidate bios and election statements. AORN Foundation Report Paula Graling, DNP, RN, CNOR, FAAN, President of the AORN Foundation Board of Trustees, gave the AORN Foundation report. The AORN Foundation had a record year in 2013, earning $2.7 million. “We invested in the next generation,” Graling said, by providing $650,000 to 49 students AORN Journal j 711
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The 2014e2015 Nominating and Leadership Development Committee. (From left) Mary Russell, chair; Karen Lemmons; Vangie Dennis; Rosemarie Schroeder, advisor; Merideth Lewis-Cooney; and Stephen Balog.
pursuing a career in perioperative nursing and 300 nurses interested in attending continuing education conferences for professional development. This represented a two-fold increase from previous funding years. The AORN Foundation also allocated $1.3 million for the development of new educational resources and training tools for perioperative nursing. Graling received a round of applause when she said that $0.89 of every $1 earned goes directly toward funding AORN Foundation programs. “Even in these tough economic times, the AORN Foundation has been able to keep our promise and award scholarships,” Graling added. The AORN Foundation began the year by awarding more than $500,000 in grants to help nurses attend the AORN Surgical Conference & Expo. “Please remember that the Foundation is a separate entity from AORN, Inc, and member dues do not fund the programs,” Graling said. “We rely on your support.” In closing, Graling announced that as of April 1, total donations and sponsorships earned equaled $183,000.
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The 2014e2015 Board of Directors. (Back row from left) Stephanie Davis, Karen Knapp, Holly Ervine, Melanie Braswell, Donna Ford, Sandy Albright, and Missi Merlino. (Front row from left) Secretary Nathalie Walker, President-Elect Renae Battie´ , President Victoria Steelman, Vice President Callie Craig, and Treasurer Martha Stratton.
Committee, announced that out of 44,051 eligible voters, 2,016 cast ballots. n
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Members newly elected to the NLDC are n Stephen Balog, MSN, BSN, RN, CNOR; n Vangie Dennis, BSN, RN, CMLSO, CNOR; and n Merideth Lewis-Cooney, BSN, RN, CNOR. Members newly elected to the Board of Directors are n Holly S. Ervine, BSN, RN, CNOR; n Donna A. Ford, MSN, RN-BC, CNOR, CRCST; and n Missi Merlino, MHA, RN-BC, CNOR. The Secretary is Nathalie Walker, MBA, RN, CNOR. The Vice President is Callie Craig, MS, BSN, RN, CNOR. The President-elect is Renae N. Battie´, MN, RN, CNOR. KIMBERLY J. RETZLAFF MANAGING EDITOR
ELECTION RESULTS At the end of the second session of the House of Delegates, Kelly Kollar, chair of the Teller’s 712 j AORN Journal
Editor’s notes: AORN Syntegrity and Periop 101 are registered trademarks of AORN, Inc, Denver, CO.