Session: Advocacy in action—Empowering your teams toward successful legislative integration, safety excellence

Editor's Note

Advocacy begins where safety meets purpose. That was the resounding message from UF Health Shands’ Michele Brunges, MSN, RN, CNOR, CHSE, director of surgical services; Katherine Hayes, BSN, RN, CNOR-CARD, nursing professional development specialist for perioperative services; and Kristy Perry, MSN, RN, CNOR, clinical coordinator of the north tower operating room. Legislative advocacy is not politics, but patient safety. “Advocacy isn’t just for politicians,” they said. “It’s an essential leadership skill in healthcare.”

Speaking on the push for smoke-free ORs, the panel explained that surgical smoke, generated by energy-based tools such as electrocautery, exposes OR teams to toxins, viruses, and carcinogens, increasing risks of respiratory illness and even cancer. Yet, as of late 2024, only a handful of states had enacted smoke evacuation laws. “Without legislation, many hospitals deprioritize smoke evacuation because of cost,” Brunges said. “That’s why nurse leaders must drive the conversation.”

Their strategy began with education. The team hosted in-services, collected data, and built coalitions with professional organizations like AORN and the Florida Nurses Association. “Start small,” Perry urged. “Choose one legislative priority—like smoke-free ORs—and align with others who share your vision.” Personal storytelling proved powerful. “When we met with legislators in Tallahassee, we talked about the babies born by C-section whose first breath might contain surgical smoke,” said Hayes. “It made the issue real.”

UF Health Shands’ journey from awareness to full implementation spanned just over a year. After attending the OR Manager Conference in 2023, Perry and her colleagues launched their internal campaign. “We recognized a gap in our practice,” she said. Baseline data showed fewer than 5% of cases used smoke evacuation. By involving surgical technologists, anesthesia, and supply chain partners, that number steadily rose. Monthly data reviews and transparent progress reports kept department chairs and staff accountable.

By late 2024, UF Health Shands achieved full adoption of smoke evacuation in every case generating surgical plume. The team standardized equipment, replacing traditional pencils with smoke evacuation versions in OR packs. “We gave our teams the tools they needed,” Perry said. “That simple access drove compliance.”

That proactive stance set a statewide example. Although Florida’s House Bill 63—which would have mandated smoke evacuation—failed in 2024, UF Health Shands pressed on. “We didn’t wait for lawmakers,” Hayes said. “We acted because it was the right thing to do.” In February 2025, the team met again with state senators to advocate for reintroducing the bill, sharing their outcomes and inviting legislators to tour the OR.

Their efforts earned national recognition. In April 2025, the North Tower Operating Room received AORN’s Go Clear Award for its comprehensive education, policy integration, and cultural change around surgical smoke safety. “Our staff owned this success,” Perry said. “They educated surgeons, advocated for peers, and proved that nurses can lead legislative change from the ground up.”

Beyond smoke evacuation, the presenters connected advocacy to a broader leadership mindset. At UF Health Shands, legislative awareness is woven into orientation and competency processes, ensuring every nurse understands how policy affects practice. The team cited major state and national wins—such as full practice authority for APRNs and strengthened infection control protocols—as examples of how advocacy shapes care delivery.

“Legislation doesn’t just regulate healthcare—it catalyzes innovation,” Brunges said. “When nurses know the policies shaping their work, they become stronger advocates and safer clinicians.” The session closed with a reminder that change often begins small. “It started with three nurses and a conversation after a conference,” Perry reflected. “If we can do it, so can you. Every OR can be smoke-free, one policy and one patient at a time.”