M Editorial

Courtships don’t always lead to a marriage The specialty nursing organizations are being courted, but it is not apparent that they want to get married.

The National Federation for Specialty Nurs- ing Organizations is growing in visibility. With a broader membership base, including the Na- tional League for Nursing and now the Ameri- can Society for Nursing Service Adminis- trators, it seems to have more clout.

There is some pressure on the Federation to become a “voice” for nursing. A small group of nursing leaders, dissatisfied with the American Nurses’ Association (ANA), has called on the Federation to become a “cohesive voice for nursing.” Speaking for the group, Rachel Rot- kovitch, RN, vice-president for nursing at Yale-New Haven (Conn) Hospital, proposed that nursing be unified under an umbrella or- ganization with the Federation as a nucleus. There was even an offer of money. A mystery company would provide $100,000 for the startup of such an organization.

The Federation members listened to this proposal without comment. It didn’t seem like quite the right offer of wedded bliss.

The Task Force on Credentialing in Nursing has also wooed the specialty groups. It wants them to form a coalition to start up a national credentialing center. Again, there was an offer of $100,000 in startup funds. (Was it the same $100,000?) There were a lot of unknowns, and the groups weren’t sure they wanted to get in that bed, at least at the moment. They did agree, however, to stay on speaking terms.

Then there was another proposal. Sigma Theta Tau, the nursing honorary, is inviting

nursing organizations to participate in what it is calling a National Center for Nursing. The deal is this. Sigma Theta Tau is planning to build a national office in Indianapolis. When it ap- proached the Lilly Endowment, it suggested the development of a National Center for Nurs- ing rather than a single purpose building.

At the ANA convention, Sigma Theta Tau invited other nursing organizations to break- fast and asked if they would be interested in establishing their headquarters in the same building. It was an intriguing idea. There would be several advantages, according to Sigma Theta Tau President Carol Lindeman. It would bring nursing organizations together, creating an image of unity. Shared services might re- duce costs. The closeness, of course, could breed cooperation or contempt, but at least nursing would be together. Many organiza- tions, like AORN, are locked into ownership or lease arrangements, but some were in- terested. ANA is working on moving its head- quarters to Washington, DC, and didn’t seem intrigued by Indianapolis. But it said it would listen.

ANA is also wooing the specialty nursing organizations, but what it has in mind is a tradi- tional, old-fashioned marriage. In its newly proposed ANA national credentialing center, ANA wants other organizations to participate, use the services, and pay for them, but not have much say. At the ANA Convention in June, ANA delegates made it exceedingly clear that ANA will control credentialing be- cause that‘s where the power is-also the money. ANA welcomes the specialty groups’ participation, but on its own terms. The spe- cialty nursing organizations have already ex- pressed their coolness to this kind of mat- rimony.

342 AORN Journal, September 1982, Val 36, No 3

The new ANA bylaws, which restructure ANA into a federation of state nurses' associ- ations, also have a proposal of union for the specialties. (See article in this issue on the ANA convention.) The bylaws provide for a nursing organization liaison forum, which sounds much like the current National Federa- tion for Specialty Nursing Organizations. This forum, to be composed of representatives of ANA and nursing organizations that meet ANA qualifications, would meet annually to discuss issues of common concern. That's pretty much what the Federation does, but ANA doesn't determine the qualifications.

With the radical change in ANAs structure dictated by the new bylaws, ANA will be going through an uneasy time. The changes were made because of ANAs current problems, not its strengths. Whether a new structure will solve some of those basic problems is difficult to predict. At one time, the relationships be-

tween ANA and the specialty groups were acrimonious. But in recent years, there have been cooperation and mutual support. ANA is going to need that continuing support of the specialty groups.

But ANA will also have to consider the grow- ing cohesiveness and collective strength of other nursing organizations. It may have to offer a more contemporary marriage arrange- ment, where responsibility and decision mak- ing are shared, not dictated.

In the meantime, the specialty organizations can enjoy the courtship. They can attend meet- ings, listen to proposals, and decide what they want. But it probably won't be an old-fashioned marriage. It could be a living together ar- rangement.

Elinor S Schrader Editor

Malignant hyperthermia requires fast diagnosis Malignant hyperthermia occurs without warning. Its results can be severe if not treated quickly. The hypermetabolic crisis is precipitated by inhalants and neuromuscular blocking agents used during anesthesia or other stressful situations.

The reaction is caused by an underlying muscle disease with a genetic basis. Its clinical features are caused by an imbalance in the distribution of intracellular calcium in the muscle fiber and excessive calcium in the muscle fiber. The reaction is most common among children, teenagers, and young adults. Typically, it affects a muscular man. Fatality rates over 70% have been reported, and survivors are often seriously impaired if not quickly treated.

The US Food and Drug Administration has recently approved the prophylactic use of orally administered dantrolene sodium for patients believed susceptible to the condition. The drug is available in capsule form and can be used before anesthesia is administered. Upon diagnosis, intravenous infusion of dantrolene sodium should begin. This is thought to be effective because it interferes with the release of calcium ions

from the sarcoplasmic reticulum. There are warning signals to alert the

operating room staff of potential risk. Preoperatively, a serum CPK test can be done but its results should be evaluated with caution. Of patients who are susceptible to malignant hyperthermia, 70% have high serum CPK levels. A muscle biopsy is the most definitive indicator of risk for malignant hyperthermia. Certain characteristics are common to those who are at risk of malignant hyperthermia: joint hypermobility, deformities of the spine, a tendency for joint dislocations, congenital, inguinal and other hernias, and ptosis and squint.

Malignant hyperthermia is characterized by tachycardia, tachypnea, arrhythmias, dark blood in the surgical field despite adequate inspired oxygen, cyanotic mottling of skin, unstable blood pressure, respiratory and metabolic acidosis, fever, profuse sweating and muscle rigidity.

344 AORN Journal, September 1982, Vol36, No 3