Fired Up Over Mandatory Smoke Evacuation Laws

If you've worked in an OR, you know the horror stories about surgical smoke. It could be the surgeon who never touched a cigarette suddenly developing lung cancer, the nurse who can't seem to stop coughing or the OR tech diagnosed with asthma in adulthood.

We've known about the dangers of surgical smoke for decades. Last year, in our home state of Rhode Island, we decided to do something about it. In June, the nation's smallest state made a bit of history when we passed the first law making smoke evacuation mandatory. Starting this month, all the hospitals and surgery centers in our state need to have policies on the books to protect their workers from the chemicals, carcinogens, viruses and bacteria that come with surgical smoke. Surgical staff can file reports with the state if their facilities aren't adopting or following these smoke evacuation polices.

While we're proud to be the first smoke-free state, we're hoping our story is only the beginning of a movement. It's our dream to see this initiative spread across the country. Here are 5 lessons we learned along the way that could help your state go smoke-free in the OR as well.

If you want to go smoke-free in your state, you can't do it alone. To get through the legislative process, you'll need a big coalition of supporters. This stretches beyond your perioperative nurses and your professional nurses association. Do you have endorsements from your state hospital association and your local medical society? What about your state's physician assistants? Those groups have a strong voice and sway among your local legislators. If one group isn't on board or included, it can derail your efforts to go smoke-free.

So how do you get all these groups on the same page? Stress your common interests. Smoke-filled ORs mean missed time for employees and higher smoke-related healthcare costs. Everyone who's harmed by surgical smoke should have a say in the legislative process: doctors, nurses, physician assistants and patients alike. Meet with the leaders who represent these groups, and you'll find you have much in common.

As you get started, AORN will provide critical guidance to help you get organized in your state. They've been spearheading the efforts for smoke-free legislation and policies for decades, and know the strategies that work.

2. Be persistent

You need to be prepared for setbacks. We thought we were at the finish line in 2017. Our bill had made its way through the committee process. We had received so much positive feedback. We thought we were going to get a vote, and then it didn't happen. The truth is that state legislatures are not rubber-stamping bills 12 months of the year. They actually vote on legislation in a very limited window of time. Even if you have bipartisan support — and buy-in from those medical groups and societies listed above — your bill might not make it up for a vote. The wheels of government tend to turn slowly. You need to be patient and think about the big picture.

Yes, we were disappointed that we didn't get a vote in the first year, but we came back reinvigorated in year 2, with even more proponents on our side to make our case.

3. Analogies and anecdotes

When you work in the OR, you assume everyone knows about the perils of surgical smoke. Once you get started down this legislative path, you'll learn that's not the case. The best way to raise awareness of the dangers of surgical smoke? It really hits home for lawmakers when they learn a day in a smoke-filled OR is like smoking 27 to 30 unfiltered cigarettes. Paint a vivid picture with anecdotes, like the nurse who testified about how a passer-by could see the smoke seeping under the door when surgery was in session. That kind of vivid detail shows just how much smoke we're dealing with on a daily basis.

4. Show, don't tell

Think about ways you can drive the message home that go beyond the talking points and testimony. As we were making our pitch, we invited the chair of the House committee on Health, Education and Welfare to our AORN conference in Boston. It was one thing for him to hear about the dangers of surgical smoke. It was another for him to use the equipment and see the smoke that's produced from surgery with his own eyes. He also got a chance to speak with our OR nurses and to learn from the manufacturers whose products can keep the air clean.

5. Finish line follow-up

Your work's just beginning once a law's enacted. This is an exciting time for us here in Rhode Island, as our hospital and surgery centers submit their smoke-free policies to the state Department of Health. Now it's time to make sure they're putting those policies into practice. We'll continue to seek feedback from our nurses in our ORs to ensure these new policies are being followed.

It'll be a bit of a culture change for some surgeons and facilities to use smoke-evacuation tools, but that's no longer an acceptable excuse for an unhealthy workplace. The training to use these evacuation systems is readily available and the cost for a smoke-evacuation pencil is only about $3 to $5 more than the traditional options. OSM

You need to be prepared for setbacks. We thought we were at the finish line in 2017. Our bill had made its way through the committee process. We had received so much positive feedback. We thought we were going to get a vote, and then it didn't happen. The truth is that state legislatures are not rubber-stamping bills 12 months of the year. They actually vote on legislation in a very limited window of time. Even if you have bipartisan support — and buy-in from those medical groups and societies listed above — your bill might not make it up for a vote. The wheels of government tend to turn slowly. You need to be patient and think about the big picture.

Yes, we were disappointed that we didn't get a vote in the first year, but we came back reinvigorated in year 2, with even more proponents on our side to make our case.

Think about ways you can drive the message home that go beyond the talking points and testimony. As we were making our pitch, we invited the chair of the House committee on Health, Education and Welfare to our AORN conference in Boston. It was one thing for him to hear about the dangers of surgical smoke. It was another for him to use the equipment and see the smoke that's produced from surgery with his own eyes. He also got a chance to speak with our OR nurses and to learn from the manufacturers whose products can keep the air clean.