PRESIDENT’S MESSAGE
Thriving Through Trust: Ethical Practice, Quality Care MN, RN, CNOR, AORN PRESIDENT RENAE N. BATTIE,
A
ldo Leopold once said that “Ethical behavior is doing the right thing when no one else is watchingdeven when doing the wrong thing is 1 legal.” As a Seattle Seahawks fan and sports nut, I could not pass up the chance to mention the fun that football fans had with “Deflategate” just prior to Super Bowl XLIX.2 The controversy around the deflated footballs used in the American Football Conference Championship Game certainly raised ethical concerns about the New England Patriots’ approach to playing the game. It may not have changed the outcome of the game, but the aspersions cast on the team and the players will be remembered regardless. Recently, Brian Williams, a highly respected news anchor, was discovered to have been untruthful in his story about his participation in a war zone helicopter flight. He admitted that he exaggerated his role and that he “misremembered.”3 I heard radio show hosts discussing how the reaction to Williams’ choices might affect the entire news industry. They mentioned how, as reporters, they are in the “believability” industry, and the public needs to trust them to tell the truth. In telling something other than the truth, Williams cast the industry as a whole in a poor light. Williams was required to take a six-month unpaid leave of absence, and surely this will have a serious effect on his future as a reporter. For the past 13 years, nurses have had the distinguished reputation as the most highly trusted professionals, as reflected in Gallup Poll results.4 This is truly impressive given the intimate, intense, and often high-stakes activities that nurses are involved in as part of providing care to each and every one of our patients. It means that, again and again, we prove this trust is well placed. Lapses in following sports rules or inaccuracies in a news story can ruin a career, but lapses in credibility for
what a nurse does or says can be devastating to a patient’s health. Nurses are definitely in the “believability” business and we have been very successful in making sure this image continues, nurse by nurse, day by day, year by year.
THE YEAR OF ETHICS AND QUALITY CARE This year, National Nurses Week (May 6e12) will have the theme “Ethical Practice. Quality Care.”5 This theme recognizes the impact of ethical nursing practice on patient outcomes and the quality of care delivered. In fact, the American Nurses Association (ANA) has designated 2015 as the Year of Ethics. Pamela F. Cipriano, PhD, RN, NEABC, FAAN, ANA president, says, “The public places its faith in nurses to practice ethically. A patient’s health, autonomy, and even life or death, can be affected by a nurse’s decisions and actions. ANA believes it’s important that all nurses practice at the highest ethical level, and therefore, we will be offering a full range of activities to inform and support nurses to achieve that goal in a stressful and ever-changing health care environment.”6 Nurses can participate in a variety of educational opportunities centered on ethics this year. For example, in June, the ANA will host an ethics symposium. Many of the presentations will be repurposed in webinars that will be available throughout the year. Please watch for announcements about these very valuable resources. They provide a great opportunity to expand your knowledge and expertise in ethical issues that affect nursing practice.
Ethical Practice The original ANA Code of Ethics for Nurses With Interpretive Statements was released in 2001, and it was revised in 2015.
http://dx.doi.org/10.1016/j.aorn.2015.03.008 ª AORN, Inc, 2015
www.aornjournal.org
AORN Journal j 505
Batti e
May 2015, Volume 101, No. 5
This update ensures that the Code of Ethics continues to be relevant with the transformations in health care delivery and modern clinical practice advances.
Perioperative evidence-based practices and guidelines are part of continually raising the bar for excellence and focusing on the right care at the right time.
AORN publishes the “Perioperative explications for the ANA Code of Ethics for Nurses”7 to specifically apply these principles to the specialty area of perioperative nursing. With the update to the original Code of Ethics, an AORN task force will be reviewing the changes and updating the perioperative nursing document. The health care world has changed tremendously in the past decade, and it is important to keep this document relevant and clear for perioperative practice. Kathryn Schroeter, PhD, RN, CNE, CNOR, participated in the ANA revision as a member of the ANA Code of Ethics Revision Professional Issues Panel Steering Committee, and she will lead the work on the AORN document. We are fortunate to have her expertise to guide this work.
AORN partnered with ANA and other nursing groups to expand the National Database of Nursing Quality Indicators measures of nurse staffing to identify the connection between nurse staffing and patient outcomes.11 The perioperative area has unique complexities because of shorter patient stays compared with other nursing units and teams comprising individuals from multiple disciplines. Establishing links between outcomes and nurse staffing characteristics is important work and has enormous potential to improve patient outcomes and enhance patient safety.
Many demands in our health care environments make it challenging to consistently deliver highly effective ethical care. The new Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit8 describes a plan for nurses to influence changes that improve work environments and health and quality outcomes. This work was the result of ANA participation as a strategic partner in the National Nursing Ethics Summit convened by Johns Hopkins University’s Berman Institute of Bioethics and School of Nursing to strengthen ethics in the profession. This is aligned with the work that AORN is doing related to healthy work environments through updating our position statement, “Key Components of a Healthy Perioperative Work Environment.”9 The AORN Clinical Nursing Practice Committee will continue its work this year in creating additional resources and a tool kit for AORN members to evaluate and improve perioperative environments. The new ANA blueprint will be another resource to support AORN’s work in this area.
Quality Care The recognition of the impact of nursing on quality care continues to grow. Think of the powerful message of the Institute of Medicine’s Future of Nursing: Leading Change, Advancing Health10 report that identified the role of nursing in providing quality outcomes across the continuum of care and facilitating the connections between the phases of care. Certainly, perioperative nurses provide a great example of the connecting role between the phases of perioperative care. Perioperative nurses provide the information and hand overs to enable the care team to coordinate the appropriate, timely, and effective care needed during each phase of care. 506 j AORN Journal
Eight of AORN’s guidelines from the Guidelines for Perioperative Practice (formerly Perioperative Standards and Recommended Practices) have been accepted into the National Guidelines Clearinghouse,12 a department of the Agency for Healthcare Research and Quality that is a resource for clinical standards and practice. These guidelines are used by the Centers for Medicare & Medicaid Services and The Joint Commission as the standards for appropriate care. It is important recognition of the work and mission of AORN and its members to drive higher standards of care based on evidence for the quality and safety of perioperative patient care. AORN also participates in the goals of the National Quality Strategy for better care, affordable care, and healthy people and populations by working to reduce surgical site infections (SSIs). Recent results from the Centers for Medicare & Medicaid Services reflect a reduction in health careeacquired infections, specifically SSIs, and hospital readmissions.13 Our evidence-based guidelines for infection prevention are part of raising the bar for effective interventions to reduce the incidence of SSIs and therefore reduce harm to patients and reduce the costs of care.
CONCLUSION Nurses have a legacy of making a difference as a profession and being trusted by the public. Nurses are on stage all the timed whether at work, in the neighborhood, in church, or on a sports team. I do not need to know every nurse to have the confidence that every time a nurse interacts with a patient, he or she will demonstrate the behaviors and excellence that reinforce the legacy. In perioperative nursing, we highly value our role as advocates for patients during a surgical procedure. Our patients trust us to care for them during a foreign, often frightening, and certainly high-risk event in their lives. We speak for them
www.aornjournal.org
May 2015, Volume 101, No. 5
President’s Message
The AORN and ANA Partnership AORN has a highly valued partnership with the American Nurses Association (ANA) as a premier organizational affiliate. AORN was the first specialty organization to form this strong business relationship with the ANA, and as a result, AORN has an enhanced presence and voice within the ANA.1 AORN members have an ANA membership as part of their AORN membership, and this gives AORN members easier access to the resources ANA offers nurses. 1. Daley KA. The ANA and AORN: an enduring partnership for safety. AORN J. 2014;100(3):328-331.
when they cannot speak for themselves. Our promise to them is to facilitate a smooth return to their preprocedure healthy state or an improvement of such. As part of our care, we also help ensure that family members and loved ones have the information they need to support the patient during this period. This is a special year of recognizing the importance of ethics and quality for nursing as we celebrate “Ethical Practice. Quality Care” for National Nurses Week. Thank you to each and every one of you for making sure that legacy of ethics and quality continues by what you do each and every day. Thank you for truly being in the “believability” business and, year after year, reinforcing the trust of our profession to the public.
References 1. Aldo Leopold Quotes e A Sand County Almanac. http://asand countyalmanac.weebly.com/aldo-leopold-quotes.html. Accessed March 6, 2015. 2. O’Connor I. Robert Kraft had better be right. January 27, 2015. ESPN. http://espn.go.com/nfl/playoffs/2014/story/_/id/12234151/ robert-kraft-huge-loser-new-england-patriots-found-responsible -deflategate. Accessed February 16, 2015. 3. Engel P. Brian Williams explains how he “misremembered” the Iraq helicopter incident. February 10, 2015. Business Insider. http:// www.businessinsider.com/brian-williams-explains-how-he-misre membered-the-iraq-helicopter-incident-2015-2. Accessed February 16, 2015.
www.aornjournal.org
4. Riffkin R. Americans rate nurses highest on honesty, ethical standards. December 18, 2014. Gallup. http://www.gallup.com/poll/ 180260/americans-rate-nurses-highest-honesty-ethical-standards .aspx. Accessed February 16, 2015. 5. National Nurses Week 2015. American Nurses Association. http:// nursingworld.org/NationalNursesWeek. Accessed February 16, 2015. 6. The year of ethics commences with first revision of code since 2001. January 6, 2015. American Nurses Association. http:// www.nursingworld.org/FunctionalMenuCategories/MediaResources/ PressReleases/The-Year-of-Ethics-Commences-with-First-Revision -of-Code-since-2001.html. Accessed February 16, 2015. 7. Perioperative explications for the ANA Code of Ethics for Nurses. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:711-732. 8. A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit. Johns Hopkins Berman Institute of Bioethics. http://www.bioethicsinstitute.org/nursing-ethics-summit-report. Accessed February 16, 2015. 9. Position statements. AORN. https://www.aorn.org/Clinical_Practice/ Position_Statements/Position_Statements.aspx. Accessed February 16, 2015. 10. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2010. http://thefutureofnursing.org. Accessed February 16, 2015. 11. Daley KA. The ANA and AORN: an enduring partnership for safety. AORN J. 2014;100(3):328-331. 12. Association of periOperative Registered Nurses (AORN). National Guideline Clearinghouse; Agency for Healthcare Research and Quality. http://www.guideline.gov/browse/by-organization.aspx? orgid¼2345. Accessed February 16, 2015. 13. Efforts to improve patient safety result in 1.3 million fewer patient harms. Agency for Healthcare Research and Quality. http://www .ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate 2013.html. Accessed February 16, 2015.
, MN, RN, CNOR Renae N. Battie is the AORN President and the associate vice president, Perioperative Services, at Franciscan Health System, Tacoma, WA. Ms Batti e has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal j 507
Thriving Through Trust: Ethical Practice, Quality Care MN, RN, CNOR, AORN PRESIDENT RENAE N. BATTIE,
A
ldo Leopold once said that “Ethical behavior is doing the right thing when no one else is watchingdeven when doing the wrong thing is 1 legal.” As a Seattle Seahawks fan and sports nut, I could not pass up the chance to mention the fun that football fans had with “Deflategate” just prior to Super Bowl XLIX.2 The controversy around the deflated footballs used in the American Football Conference Championship Game certainly raised ethical concerns about the New England Patriots’ approach to playing the game. It may not have changed the outcome of the game, but the aspersions cast on the team and the players will be remembered regardless. Recently, Brian Williams, a highly respected news anchor, was discovered to have been untruthful in his story about his participation in a war zone helicopter flight. He admitted that he exaggerated his role and that he “misremembered.”3 I heard radio show hosts discussing how the reaction to Williams’ choices might affect the entire news industry. They mentioned how, as reporters, they are in the “believability” industry, and the public needs to trust them to tell the truth. In telling something other than the truth, Williams cast the industry as a whole in a poor light. Williams was required to take a six-month unpaid leave of absence, and surely this will have a serious effect on his future as a reporter. For the past 13 years, nurses have had the distinguished reputation as the most highly trusted professionals, as reflected in Gallup Poll results.4 This is truly impressive given the intimate, intense, and often high-stakes activities that nurses are involved in as part of providing care to each and every one of our patients. It means that, again and again, we prove this trust is well placed. Lapses in following sports rules or inaccuracies in a news story can ruin a career, but lapses in credibility for
what a nurse does or says can be devastating to a patient’s health. Nurses are definitely in the “believability” business and we have been very successful in making sure this image continues, nurse by nurse, day by day, year by year.
THE YEAR OF ETHICS AND QUALITY CARE This year, National Nurses Week (May 6e12) will have the theme “Ethical Practice. Quality Care.”5 This theme recognizes the impact of ethical nursing practice on patient outcomes and the quality of care delivered. In fact, the American Nurses Association (ANA) has designated 2015 as the Year of Ethics. Pamela F. Cipriano, PhD, RN, NEABC, FAAN, ANA president, says, “The public places its faith in nurses to practice ethically. A patient’s health, autonomy, and even life or death, can be affected by a nurse’s decisions and actions. ANA believes it’s important that all nurses practice at the highest ethical level, and therefore, we will be offering a full range of activities to inform and support nurses to achieve that goal in a stressful and ever-changing health care environment.”6 Nurses can participate in a variety of educational opportunities centered on ethics this year. For example, in June, the ANA will host an ethics symposium. Many of the presentations will be repurposed in webinars that will be available throughout the year. Please watch for announcements about these very valuable resources. They provide a great opportunity to expand your knowledge and expertise in ethical issues that affect nursing practice.
Ethical Practice The original ANA Code of Ethics for Nurses With Interpretive Statements was released in 2001, and it was revised in 2015.
http://dx.doi.org/10.1016/j.aorn.2015.03.008 ª AORN, Inc, 2015
www.aornjournal.org
AORN Journal j 505
Batti e
May 2015, Volume 101, No. 5
This update ensures that the Code of Ethics continues to be relevant with the transformations in health care delivery and modern clinical practice advances.
Perioperative evidence-based practices and guidelines are part of continually raising the bar for excellence and focusing on the right care at the right time.
AORN publishes the “Perioperative explications for the ANA Code of Ethics for Nurses”7 to specifically apply these principles to the specialty area of perioperative nursing. With the update to the original Code of Ethics, an AORN task force will be reviewing the changes and updating the perioperative nursing document. The health care world has changed tremendously in the past decade, and it is important to keep this document relevant and clear for perioperative practice. Kathryn Schroeter, PhD, RN, CNE, CNOR, participated in the ANA revision as a member of the ANA Code of Ethics Revision Professional Issues Panel Steering Committee, and she will lead the work on the AORN document. We are fortunate to have her expertise to guide this work.
AORN partnered with ANA and other nursing groups to expand the National Database of Nursing Quality Indicators measures of nurse staffing to identify the connection between nurse staffing and patient outcomes.11 The perioperative area has unique complexities because of shorter patient stays compared with other nursing units and teams comprising individuals from multiple disciplines. Establishing links between outcomes and nurse staffing characteristics is important work and has enormous potential to improve patient outcomes and enhance patient safety.
Many demands in our health care environments make it challenging to consistently deliver highly effective ethical care. The new Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit8 describes a plan for nurses to influence changes that improve work environments and health and quality outcomes. This work was the result of ANA participation as a strategic partner in the National Nursing Ethics Summit convened by Johns Hopkins University’s Berman Institute of Bioethics and School of Nursing to strengthen ethics in the profession. This is aligned with the work that AORN is doing related to healthy work environments through updating our position statement, “Key Components of a Healthy Perioperative Work Environment.”9 The AORN Clinical Nursing Practice Committee will continue its work this year in creating additional resources and a tool kit for AORN members to evaluate and improve perioperative environments. The new ANA blueprint will be another resource to support AORN’s work in this area.
Quality Care The recognition of the impact of nursing on quality care continues to grow. Think of the powerful message of the Institute of Medicine’s Future of Nursing: Leading Change, Advancing Health10 report that identified the role of nursing in providing quality outcomes across the continuum of care and facilitating the connections between the phases of care. Certainly, perioperative nurses provide a great example of the connecting role between the phases of perioperative care. Perioperative nurses provide the information and hand overs to enable the care team to coordinate the appropriate, timely, and effective care needed during each phase of care. 506 j AORN Journal
Eight of AORN’s guidelines from the Guidelines for Perioperative Practice (formerly Perioperative Standards and Recommended Practices) have been accepted into the National Guidelines Clearinghouse,12 a department of the Agency for Healthcare Research and Quality that is a resource for clinical standards and practice. These guidelines are used by the Centers for Medicare & Medicaid Services and The Joint Commission as the standards for appropriate care. It is important recognition of the work and mission of AORN and its members to drive higher standards of care based on evidence for the quality and safety of perioperative patient care. AORN also participates in the goals of the National Quality Strategy for better care, affordable care, and healthy people and populations by working to reduce surgical site infections (SSIs). Recent results from the Centers for Medicare & Medicaid Services reflect a reduction in health careeacquired infections, specifically SSIs, and hospital readmissions.13 Our evidence-based guidelines for infection prevention are part of raising the bar for effective interventions to reduce the incidence of SSIs and therefore reduce harm to patients and reduce the costs of care.
CONCLUSION Nurses have a legacy of making a difference as a profession and being trusted by the public. Nurses are on stage all the timed whether at work, in the neighborhood, in church, or on a sports team. I do not need to know every nurse to have the confidence that every time a nurse interacts with a patient, he or she will demonstrate the behaviors and excellence that reinforce the legacy. In perioperative nursing, we highly value our role as advocates for patients during a surgical procedure. Our patients trust us to care for them during a foreign, often frightening, and certainly high-risk event in their lives. We speak for them
www.aornjournal.org
May 2015, Volume 101, No. 5
President’s Message
The AORN and ANA Partnership AORN has a highly valued partnership with the American Nurses Association (ANA) as a premier organizational affiliate. AORN was the first specialty organization to form this strong business relationship with the ANA, and as a result, AORN has an enhanced presence and voice within the ANA.1 AORN members have an ANA membership as part of their AORN membership, and this gives AORN members easier access to the resources ANA offers nurses. 1. Daley KA. The ANA and AORN: an enduring partnership for safety. AORN J. 2014;100(3):328-331.
when they cannot speak for themselves. Our promise to them is to facilitate a smooth return to their preprocedure healthy state or an improvement of such. As part of our care, we also help ensure that family members and loved ones have the information they need to support the patient during this period. This is a special year of recognizing the importance of ethics and quality for nursing as we celebrate “Ethical Practice. Quality Care” for National Nurses Week. Thank you to each and every one of you for making sure that legacy of ethics and quality continues by what you do each and every day. Thank you for truly being in the “believability” business and, year after year, reinforcing the trust of our profession to the public.
References 1. Aldo Leopold Quotes e A Sand County Almanac. http://asand countyalmanac.weebly.com/aldo-leopold-quotes.html. Accessed March 6, 2015. 2. O’Connor I. Robert Kraft had better be right. January 27, 2015. ESPN. http://espn.go.com/nfl/playoffs/2014/story/_/id/12234151/ robert-kraft-huge-loser-new-england-patriots-found-responsible -deflategate. Accessed February 16, 2015. 3. Engel P. Brian Williams explains how he “misremembered” the Iraq helicopter incident. February 10, 2015. Business Insider. http:// www.businessinsider.com/brian-williams-explains-how-he-misre membered-the-iraq-helicopter-incident-2015-2. Accessed February 16, 2015.
www.aornjournal.org
4. Riffkin R. Americans rate nurses highest on honesty, ethical standards. December 18, 2014. Gallup. http://www.gallup.com/poll/ 180260/americans-rate-nurses-highest-honesty-ethical-standards .aspx. Accessed February 16, 2015. 5. National Nurses Week 2015. American Nurses Association. http:// nursingworld.org/NationalNursesWeek. Accessed February 16, 2015. 6. The year of ethics commences with first revision of code since 2001. January 6, 2015. American Nurses Association. http:// www.nursingworld.org/FunctionalMenuCategories/MediaResources/ PressReleases/The-Year-of-Ethics-Commences-with-First-Revision -of-Code-since-2001.html. Accessed February 16, 2015. 7. Perioperative explications for the ANA Code of Ethics for Nurses. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:711-732. 8. A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit. Johns Hopkins Berman Institute of Bioethics. http://www.bioethicsinstitute.org/nursing-ethics-summit-report. Accessed February 16, 2015. 9. Position statements. AORN. https://www.aorn.org/Clinical_Practice/ Position_Statements/Position_Statements.aspx. Accessed February 16, 2015. 10. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2010. http://thefutureofnursing.org. Accessed February 16, 2015. 11. Daley KA. The ANA and AORN: an enduring partnership for safety. AORN J. 2014;100(3):328-331. 12. Association of periOperative Registered Nurses (AORN). National Guideline Clearinghouse; Agency for Healthcare Research and Quality. http://www.guideline.gov/browse/by-organization.aspx? orgid¼2345. Accessed February 16, 2015. 13. Efforts to improve patient safety result in 1.3 million fewer patient harms. Agency for Healthcare Research and Quality. http://www .ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate 2013.html. Accessed February 16, 2015.
, MN, RN, CNOR Renae N. Battie is the AORN President and the associate vice president, Perioperative Services, at Franciscan Health System, Tacoma, WA. Ms Batti e has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal j 507
