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Improving circulation

August 22, 2006 -- Today the Mid-Hudson News Network site reported that New York Governor George Pataki had vetoed a bill that would have required a circulating nurse to be present during surgeries in the state. The short item consists almost entirely of comment from the bill's author, Assemblywoman Aileen Gunther, a nurse. Gunther does a good job of explaining the specific things OR nurses do to coordinate surgical activities and advocate for patients. Her bill seems to present a variation on the unit-based nurse:patient staffing ratios enacted in California, since it links nurse staffing to a specific activity, the operation. Presumably this reflects the distinct nature of the OR, where patients do not stay 24/7.

The piece's headline is "Gunther bill to require a registered nurse in operating room vetoed." Although that makes it sound like the bill simply required one nurse to be present in the OR, the text reports that the bill applied to circulating nurses. The item does not indicate whether the proposed legislation dealt with scrub nurses, who stay by the patient's side during operations; perhaps the reporter was not fully aware of the distinction. The piece also does not say if the bill applied only to certain types of facilities or surgical procedures.

In any case, the piece reports that Gunther describes the work of circulating nurses as

completing and verifying surgical instruments, verifying patient identification, ensuring correct site surgery, assessing the patient for allergies to drugs and other important conditions. They also maintain infection control, oversee blood transfusions and coordinate the use of surgical instruments and monitoring devices.

The piece also has some good direct quotes from Gunther. She says that because patients can't make their own decisions in the OR, the "circulating nurse serves as the patient's advocate for the entire procedure and is the only person solely dedicated to monitoring the patient and all of the proceedings." She also notes that the circulating nurse "manages the nursing care within the operating room and makes sure the surgical team members perform their duties in sync." Naturally, Gunther was disappointed at the veto of her bill, which she said would have helped "ensure the safety of patients during their most vulnerable period." The piece says Gunther is a "former emergency room nurse." That makes us somewhat uncomfortable, since descriptions of "former" nurses tend to suggest that nursing is less a profession than a job. However, it is presumably correct that Gunther no longer works in the ED.

Gunther's reported comments give readers a good sense of the specific duties of the circulating nurse. In particular, the piece makes clear that the nurse's duties are critical to the patient's physical wellbeing. And there is no suggestion that the nurse is simply serving the surgeon. The piece does not explain how Gunther's bill came about. But we note that it appears to be an effort to insure a certain level of nurse staffing as to a specific procedure, rather than setting an overall nurse:patient ratio for a given unit. Of course, if we consider the OR to be unit, we might say that this bill would set the circulating nurse to patient ratio at 1:1. The piece might have including some indication of why Gov. Pataki vetoed the bill. Whatever the merits of this specific proposal, it seems to us that efforts by nurse legislators to improve care through bills like this are strong examples of patient advocacy.

We thank the Mid-Hudson News Network for this generally helpful piece and applaud Assemblywoman Aileen Gunther for her nursing and patient advocacy.

The article does not appear to be available online at this time.

You can send the Mid-Hudson News Network thanks for this piece at

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