the performance appraisal process. A code of ethics can guide nurses in their routine daily activities with patients and colleagues, but the results must be measured.

Attitudes cannot be measured, but we can measure the following behaviors. Does the employee demonstrate respectful and re- sponsive behaviors to all individuals with whom they come in contact? Are they sensitive to the problems, needs, and concerns of pa- tients and their families? Do they work cooperatively and effectively with other em- ployees in the department? Do they maintain professional conduct at all times? Do they rep- resent fairly and objectively the mission and goal of the department as they relate to the overall goals of the institution?

As professionals, we are accountable to our patients and ourselves. We should not over- look our colleagues’ inappropriate behavior. We must discuss those behaviors formally and informally with the individuals involved.

Maria Phaneuf has stated that “Accountabil- ity is the hallmark of a mature profession.” Nurse managers have the responsibility to serve as role models for their colleagues.

Our profession cannot and will not mature without individual accountability, and that accountability must be measured through peer assessment and performance appraisals.

Linda Groah, RN, CNOR Director of Nursing Operating & RR

Assistant Director Hospitals & Clinics University of California, San Francisco

Technicians threat to OR nurses

When I saw the Association of Surgical Technologists (AST) newsletter, I suffered a case of professional indignation. I recognize ASTs right to organize and protest, but I strongly object to the message and tone of the newsletter. To give you a feeling of the mes- sage in the newsletter, I quote the following statements:

It is the position of AST that the ability to assess ‘various patient signs, symptoms and responses’ is not imperative nor a re- quirement for functioning in the role of cir- culator. In the operating room during

surgery, the time when the circulator is func- tioning, it is the surgeon and the anesthetist who have the responsibility for assessing the patient’s signs, symptoms and re- sponses. The certified Surgical Technolo- gist (CST) is as qualified as the registered nurse to perform the functions of scrub or circulator in the operating room-by virtue of their extensive education and experience in the operating room. . . .

The term ‘lesser trained’ personnel is riot appropriate when referring to qualified sur- gical technologists as circulators.

Today’s registered nurse may or may not be trained in operating room techniques and procedures and may or may not be certified in the operating room. As a result of nursing programs curtailling (sic) or altogether eliminating operating room coursework from their curriculum, many registered nurses en- tering the operating room know very little or nothing about operating room functions and are frequently trained by the qualified surgi- cal technologists working in the operating room. This newsletter is evidence that there is a

group of nonlicensed health care workers who want to take over OR nursing. In other words, OR nurses’ jobs are on the line.

Furthermore, hospital administrators are opening Pandora’s box if they support the AST position. Today’s inexpensive OR tech will be- come tomorrow’s highly paid surgical technol- ogist if the RN is eliminated from the OR. Cost will skyrocket while quality plumments.

OR nurses must first take a long and hard look at the image they are projecting. How do other health care professionals and workers perceive the OR nursing role? If you are an OR nurse who scrubs and circulates like a robot, wipes dusty shelves, and restocks supplies rather than assessing patients, cleans and re- stocks the anesthesia machine for an indi- vidual who has two hands just like you, fetches coffee and sweet rolls for the surgeons and anesthesiologists, fights with your peers ior the attention and praise from the surgeons, and lets the surgeons and anesthesiologists practice nursing for you, then a surgical technologist can do just as well.

But if you are an OR nurse who scrubs with intelligence, circulates with a finesse that blends technical skills with professional exper-

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tise, insists on practicing the perioperative role, shuns the handmaiden role (to the institu- tion as well as the doctor), and seeks praise from your peers rather than from the medical staff, then your worth as an OR nurse is most evident.

Surgical technologists under the auspicesof AST visualize a health care system without OR nurses. I don’t like the vision. Do you?

Mark Phippen, RN San Antonio, Tex

Editor‘s note: The AST News stated that the Association of Surgical Technologists rejected the proposed 1983 Health and Human Ser- vices regulations that would, as it said, “restrict the role of the surgical technologist.” The AST News further stated that the AST Board of Directors reaffirmed its support for the 1980 HHS proposal. The 1980 proposed Medicare regulations, never finalized, would have per- mitted technicians to circulate.

A new regulation for “Hospital Conditions of Participation” for Medicare was published in the Federal Register on Jan 4. The 60-day comment period closed March 7. For other information on the regulations, see the Head- quarters report.

Accolades from author to Journal staff

During the last year, I have worked closely with the Journal staff who ably assisted me with manuscripts that were subsequently published in the Journal. They were all most patient and helpful with frequent letters and phone calls. It is hard to imagine where they acquired their knowledge of OR nursing as they are not nurses. The Journal reflects the high stan- dards set by the membership and im- plemented under the guidance of Ellie Schrader, editor. In my opinion, they are all to be congratulated for showing they care so much about OR nursing through a consistently high-quality journal.

And, a special note about Ellie. As I read her thoughtfully written editorial each month, 1 marvel how in touch she is with the feelings, frustrations, and concerns of OR nurses. She champions our cause and admonishes us for not telling the world we’re great. Many may

assume that Ellie is an RN for she speaks, not only for us, but with us. Thank you.

Billie Fernsebner, RN, CNOR Wellesley, Mass

Reader underlines importance of science, art to nursing

I feel I must comment on the January editorial criticizing Alice C Ream’s opinion, published in a Newsweek article, that nurses need less education and more job training.

While I disagree with Ream’s assessment that nurses cause poor hospital and health care, I think she made some valid observa- tions.

Within the last two decades, nursing has become a science because of the tremendous advances in science and medicine. Granted, to function as a nurse today and to be consid- ered professional, we must have a broad edu- cational base, but it is an insult to say, as Eunice Cole, ANA president, did that this base is necessary to avoid “robot, mechanical, and unthinking performance condemned by nurs- ing educators for over a century.”

During classroom education, a picture is drawn of ideal nursing situations. Reading and seeing a film strip about a particular aspect of nursing are but two mechanisms of learning. Using that classroom experience by actually doing the procedure is the third step. Each step reinforces the other and is necessary to ce- ment that piece of information into the overall picture of competent nursing practice. Know- ing the concepts behind a procedure is not enough. We must be able to perform effec- tively.

Indeed, today’s patients want more from a nurse than a tight bed and backrub. But the key word is “more.” I think they want and deserve the fine art of nursing and the science, not just the science.

The realities of the profession are to work long hours while understaffed, many times with little orientation. Many of the newer grad- uates, through no fault of their own, have not had the clinical experience. Their first job is usually on evenings or nights. They are told, “Don’t worry you won’t be alone.” In a very short time, however, they are indeed alone and this is not the time to do something for the first

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