Contra Costa County AORN 2008 Delegates Reports

Workplace Violence

This very interesting and eye opening class was given by Beverly Kirchner RN, BSN, CNOR, CASC. Beverly is on the AORN board of directors and she started this class by sharing some of her personnel experiences with workplace violence. She introduced the Council on Surgical and Perioperative Safety (CSPS) which is an incorporated multidisciplinary coalition of professional organizations whose members are involved in the care of surgical patients. The website is http:/../cspsteam.org. The session provided information regarding the research conducted on the effects of violence in the workplace. She noted that violence in the workplace cost 4.2 billion dollars a year.The class explored the impact workplace violence has on patient care/ patient safety and the health of the employees who experience this type of behavior. It gave tools to help identify behaviors that may suggest am individual may have difficulty during a crisis or difficult situations.
There are many types of workplace violence, they include, physical violence, harassment, intimidation, bullying, ganging up and gossiping. Gossip is the number one form of violence. Workplace violence causes an increase in sick calls and missed work. This puts a burden on the rest of the nursing staff causing increased stress and more sick calls. An example of this is the nurse that has an assignment that involves a difficult surgeon and calls in sick. Ms. Kirchner shared that an employer know within the first week that he or she has a difficult employee on their hands and it takes on the average ten years to get rid of a difficult employee.

Kathy McCrarey, RN, BSN, CNOR..

How’s Your Nursing “Legalese"?

Understanding the Legal Influences on Your Nursing Practice

Presented at AORN Congress 2008, March 30, 2008, Anaheim, CA
This presentation by an RN, JD discussed the legal influences on our nursing; practice. We are governed by Federal Law (HIPAA, reporting statutes), State Law (Criminal and Civil), and the Regulation (Nurse Practice Act). Much of the presentation focused on our State Boards of Nursing The speaker asked the audience at they thought was the main purpose of their State Board of Nursing. Many inthe audience thought it was to protect the nurse, but the purpose is actually “to protect the public’s health by ensuringthe safe practice of nursing”. How isthis accomplished? “…establishing overseeing, and enforcing standards of education and practice as detailed in a state’s Nurse Practice Act(NPA)” It is important to regulate Nursing because of the potential for harm if practiced by someone who is unprepared or incompetent. An example was given ofa male nurse who traveled to many different states while killing over 45 patients before he was discovered. The nurse lawyer stated you must be knowledgeable about your Nurse Practice Act! Many things violate the NPA: Negligence drug/ETOH abuse, physical abuse, theft, sexual misconduct, abandonment, unlicensed practice, fraud, felony conviction, unprofessional conduct,mental incapacity, and practice outside the scope. Especially helpful were tips for safer practice: Great documentation, good communication, avoid shortcuts, know your facility’s policies and procedures, learn from mistakes, standardize, simplify, plan ahead for crisis. Important also: Review your state’s NPA, get an attorney at the first sign of a Board problem, and last but not least; Membership in professional organizations can be beneficial (Newsletters, educational updates and conferences)!

Submitted by Bruce E. Miller, BS, RN, Charge Nurse IV, Congress 2008 Delegate

Canine Care in Preoperative Anxiety

Candise Flippen, RN, MS, CNOR
Barley Flippen, Therapy Dog When I read in the Congress brochure that one of the sessions was going to be about canine care, I knew that was what I wanted to write about. My Mom is 95 year&s old,and in a care . of the residents are nearly deaf,havedementia,or at the very least, extremey short termmemory.Many of them sit in their wheelchairs hour after hour with nothing much to keep occupied.Lots of them hold a soft cuddly stuffed toy;in their laps and when someone brings in a dog, all their faces light up, and they suddenly come to life. They love to pet the dogs, and petting seems to make them feel better.So, I thought that dogs would work well for preoperative anxiety.Assistance dogs have been used for many years, and in many ways, for example:guide dogs for the blind, hearing dogs,assistance dogs to pick up items, open and close doors and pull wheel chairs, and therapy dogs. The physical benefits of animals have been long known to lower blood pressure and reduce anxiety because dogs are nonjudgmental, calm reassuring,and you have affection on demand.The dog I met in this session was Barley; a golden retriever who was rescued in 2003.He was an extremely friendly dog that went around the large room and visited as many people as he could reach.Before Barley makes preoperative visits, he is washed and brushed thoroughly to reduce dander.The patients are evaluated to see if they are a candidate for dog therapy and the outcome of the visit isocumented. Obviously,dog allergy would prohibit a dog visit. The dogs spend time with the children before their surgery and can sometimes even walk with the dog to the door to the operating room suite. A study of twentyfive children(ages 5-18 years)who had preoperative visits with therapy dogs showed a decrease in pain perception, the need for less pain medication and a reduction in anxiety that lasted for a long time following surgery. Therapy dogs are also a valuable asset to adult patients.One case that was presented was a 68 year old female admitted for CABG. She expressed fear and anxiety regarding her surgery.The night before surgery,she spent time alone with the therapy dog, talking to him and expressing her fears to the dog. She slept well the night before the surgery and did well post operatively. Therapy dogs can even comfort family members while they are in the waiting room during their loved one's surgery. The families sometimes talked about their animals and e able to pass time with the dog and reduce stress during their wait.This was an extremely well presented and fun session. I can see how therapy dogs can be used in a variety of ways for the benefit of all patients. It was a privilege to represent our chapter at Congress and thank you for the opportunity.

Christine W. Bara, RN, BS, CNOR

2008 Congress Delegate

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