Nurse(s) Name(s) invoking Safe Harbor: 2. In Handbook of Texas Online. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. (2019). Protections are imperfect, but that does not diminish their importance. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. As chief executive of the Texas Nurses Association, Cindy leads the strategic operations of the Texas Nurses Association, a professional membership organization of registered nurses that empowers Texas Nurses to advance the profession. or local laws, rules or regulations affecting the nurse's current area of nursing practice. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. Any request for safe harbor, be it on this form or If you were an internal medicine physician and told that you, as the only doctor available, had to perform a craniotomy, would you do it? Cates, A. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. With the increasing availability of information about preventable errors and complications of hospital care, particularly those related to nursing care, hospitals were called to higher levels of accountability for patient outcomes. I have worked NICU for 31 years. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. Nurses and other front-line health care works will be the most vulnerable populations to the virus. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports.Nurses know that a culture supporting collaborative, interdisciplinary practice that encourages both identification and reporting of problems and barriers to care delivery leads to optimum patient and nurse outcomes. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Contact your BON for guidance, and if you have your own malpractice insurance (and I believe every nurse should, beyond any coverage provided by the employer) contact the carriers risk management service for additional perspective. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. The American Nurses Association ([ANA], n.d., para. However, there is a large majority who have never experienced working in disaster situations such as hurricanes, mass shootings, or disease outbreaks and therefore may not be aware of their role in the emergency preparedness process and what they can do for themselves. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. (2011). Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. This article will begin by briefly addressing the role of nurses in advocacy to advance professional practice, and offer background information about the changing healthcare industry that has influenced the example of advocacy we discuss. (2019). Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). For example, a telemetry unit in one small community hospital can compare its pressure ulcer and vacancy rates to a similar unit in another community hospital. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing advocacy. Unfortunately, many nurses and many leaders will answer the question with some form of suck it up and do the best you can. And while I know that questioning an assignment, let alone refusing it, is hard, this is exactly what you must consider doing. We conclude by considering the common thread among these exemplars. Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. 1, Manuscript 2. Consider another situation: You are an experienced nurse. (15) Safe Harbor--A process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good . To help nurses better understand when to invoke safe harbor, the Board of Nursing lists the following types of situations in which safe harbor may be applied: Nurses should be aware of their rights on the floor, including their ability to refuse a request or invoke safe harbor when they feel that such a request would put their job on the line. 476. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. As gaps in protection are identified, nurses work to address them through policy change.As gaps in protection are identified, nurses work to address them through policy change. Twenty two nurses were investigated by the Nevada State Board of Nursing for alleged violations of the Nevada Nursing Practice Act, notably failure to safeguard patients (Black, 2011). Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . Contrary to what the supervisor said, you have most of the sickest patients on the unit and it is a regular patient care assignment, including administration of chemotherapy for which you are not qualified. After the hard work is finished and the policy becomes how we practice, the origin stories are lost, and progress is often taken for granted. Are you unqualified to care for the patients assigned? Thank you! She received a BSN from University of Detroit – Mercy, magna cum laude, an MSN in adult psychiatric-mental health nursing from Wayne State University, and a PhD in nursing from University of Texas at Austin where she was recognized as the outstanding doctoral student. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. HB 2696 provided authority for the Texas Center of Nursing Workforce Studies to conduct a survey both healthcare organizations and nurses about their experiences with workplace violence (Cates, 2015). The Texas Nursing Practice Actincludes several advocacy protections for nurses. The nurse may accept the assignment and be protected from retaliation from the employer and disciplinary action from the board of nursing pending the committee's decision. State facts, include the date and time, and why you are refusing or objecting. please help the nurses reason legally to this unsafe patient services. (2015). (2019). (2016). 1525. Legislative update: TNA protects nurses in 84th session. The Texas Nursing Practice Actincludes several advocacy protections for nurses.Although policy cannot completely prevent retaliation, the Patient Advocacy Protection Bill strengthened existing protections by increasing the penalties state licensing agencies can impose. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. Thank you so much for this article! They participate in operationalizing and implementing emergency preparedness plans within their organizations, they work additional hours, they volunteer at shelters for displaced medically fragile persons, and they coordinate medical supplies, blood donations and other vital resources. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). If the nurse files Safe Harbor and the reason is to prevent unsafe care for patients' then the nurse should theoretically be safe from retaliation, but if the nurse is only protecting themselves or their license then the BON will offer little protection from consequences at their facility. Taylor, J. L. (2010). When you arrive for the day shift, you have a full house and you discover that one of the two step-down nurses is out sick. Examples: due to staffing and/or acuity of the patient(s). Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. It is offered only as information about nursing topics of interest. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Safe Harbor Nursing Peer Review (Texas Occupations Code 303.005, 2019) protects nurses who believe in good faith that they are being requested to engage in conduct that would violate a nurses duty to patient as defined in the board of nursing rules on standards of professional practice and unprofessional conduct. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. My apologies for not answering sooner. I got some help. Imagine this scenario: A nurse who has worked for 2 years in an adult medical-surgical unit reports for work and learns that she is assigned to work in neonatal intensive care that day. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. That is something you need to address with your risk manager AND absolutely worth a phone call to your state board of nursing for their guidance. (n.d.). 394. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. Choose My Signature. Beth J. Texas Nursing Voice, 7(3): 1, 3-4. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. The nurse may take the assignment or perform the service during the 14-day period, unless the assignment is one that the nurse lacks the skills necessary to competently perform. Location of requested conduct/assignment: 4. TNA developed a strategy to obtain funding for a statewide study of health care organizations (including hospitals, free-standing emergency centers, long term care facilities and homecare agencies), to validate the extent of the problem and provide the foundation for future violence prevention initiatives. The statute was implemented in 2004. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. In the fall of 2007, the Centers for Medicare and Medicaid Services (CMS) announced that it would no longer reimburse hospitals for nursing-related, preventable complications occurring during a patient hospital stay (The George Washington University, 2007). Your email address will not be published. California Assembly Bill No. Notes on Nursing (1969 ed.). The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. However, changing practice through policy does not stop with the NPA. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. I appreciate the legal advice. This protects them from facing punitive measures from their employer, losing their nursing license or being sued in court for putting a patients life in danger. As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. A joint investigation by federal and state agencies revealed violation of standard infection control practices. What else can we do to ensure their care and their safety?. Notify me of follow-up comments by email. This provision is called Safe Harbor. See Table for examples of these laws. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. I agree! A nurse must invoke safe harbor before engaging the act in question. Revision of the code in 1995 expanded it to include social ethics, global concerns, and emphasis on the important role of nurses in health policy. Other states have passed legislation (ANA, 2019) with an alternative policy approach requiring hospitals to engage nurse staffing committees in the determination of appropriate staffing levels. Solving tough problems through innovation and proven methodology. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. I am not qualified to care for these patients because I dont have the knowledge or the experience. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Citation: Martin, E., Zolnierek, C., (January 31, 2020) "Beyond the Nurse Practice Act: Making a Difference through Advocacy" OJIN: The Online Journal of Issues in Nursing Vol. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. Neither are nurses legal, professional, and ethical duties. She received an ASN from Angelo State University, a BSN and MSN from Queens University of Charlotte where she was recognized as the outstanding graduate student, and a PhD in nursing from University of Texas at Austin. The unit also has 18 general medical beds. Minimum nurse-to-patient ratios in acute care hospitals in California. 16, New York companion bills A11484, A07836, S05116, and S08358. (2015). One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. There are three variants; a typed, drawn or uploaded signature. Table. But what if the patient or their supervisor asks them to do something that would violate Board Statutes and Rules, such as falsifying medical records, performing a procedure that could harm the patient, or even assisting in criminal activity? In 2010, Texas emergency department nurse Jessica Taylor authored a commentary in the American Journal of Nursing about her experience of being assaulted at work (Taylor, 2010). A nurse may invoke safe harbor to err on the side of caution whenever they feel that their actions as requested by a patient or supervisor may violate Board Statures and Rules. Journal of Nursing Administration, 38(5): 223229. Its a wrap! NPAs have not remained stagnant over the past century, rather they have evolved but only with the active involvement of nurses in legislative efforts to change statute and update policies related to nursing practice. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. Initially, outcomes data related to nurse staffing was sparse.Measurements of quality shifted away from an interest in structure and process, and instead targeted outcomes: patient, staff, and financial. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} In addition, the ANAs Code of Ethics for Nurses (2001) spells out the RNs accountability for judgments made and actions taken in the course of nursing practice, irrespective of health care organizations policies or providers directives, (Provision 4). Ellen began her clinical practice in neuroscience nursing and for the past 20 years has focused on healthcare quality across the continuum of care from acute care hospitals, to community-based mental health, home care, and hospice. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". (2004). Texas Nurses Association. Under the Safe Harbor for Nurses act, a nurse is protected from adverse action by a facility when the nurse makes a good faith request to be allowed to reject an assignment. North Carolina Board of Nursing. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. Our hospital is expected to staff this unit. Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. This encompasses a wide range of potentially dangerous situations and criminal activity, including tampering with medical records, putting the patient, the nurse or another persons life in danger, or committing a crime of some sort. Nurse executives should support nurses who exercise their rights to protect their licenses and not view safe harbor requests as an affront to their leadership. This website also contains material copyrighted by 3rd parties. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. doi: 10.1177/1527154408319287. This assistance is covered by the SHQ (90%) and the City of Montral . (2002). Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Texas House Bill No. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . However, we recognize that there are stories from every state that highlight the valuable work of many nurses that illustrate individual and collective nursing organization advocacy. The NDNQI provided one of the first databases of patient and nurse outcome indicators and it is currently the only national database containing unit level data regarding nurse sensitive indicators. Nurses dont always have a lot of authority on the floor, so they need to learn how to protect themselves if someone asks them to do something that goes against their ethics or the law. A brief history of Florence Nightingale and her real legacy, a revolution in public health. Put your objections or refusal in writing. Safe Harbor Some states include a provision in their nurse practice act for nurses to resolve situations that they believe are unsafe or violate their duty to advocate for and protect the patient. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent.In sum, the need for evaluation of policies is vital. (2019). Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy most policy work involves collaboration among nurses and other stakeholders. Safe patient handling U.S. enacted legislation snapshot. Please enter a Recipient Address and/or check the Send me a copy checkbox. The Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). Brief explanation of why invoking Safe Harbor (It may be helpful to review rules 217.11 and 217.12): Signature(s) of Nurse(s) Invoking Safe Harbor: Recognizing this gap in protection, TNA worked with Representative Stephanie Klick, RN, one of two nurses in the Texas Legislature, to pass House Bill 2410 Oral Safe Harbor (Texas House Bill No. Recently our hospital has opened an adult unit as an overflow from the University hospital. Florence Nightingale and healthcare reform. Zolnierek, C. (2019). New York, NY: Little, Brown Book Group. This is such an unsafe situation for everyone. Although the organizational policy changes that result from implementation of grant programs may help protect the nurses who work the facilities awarded grant funds, widespread protections remain elusive despite a decade of advocacy.
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