My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. A nurse must invoke safe harbor before engaging the act in question. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. Share cases and questions with Physicians on Medscape Consult. Workplace violence study. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Black noted that while nurses are accountable for protecting patients from harm, often few protections exist for nurses raising patient safety concerns: employment at-will doctrine places nurses who witness unsafe practices in a difficult catch-22: if they report unsafe practices, they risk losing their jobs; if they dont, they risk losing their licenses. (p. 28). Required fields are marked *. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Willmann, J. The current position statement, Rights of Registered Nurses When Considering a Patient Assignment, (ANA, 2009) expressly states that nurses have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Centers for Disease Control and Prevention (2013). In the mid- to late-1990s, the American Nurses Association (ANA) led nursing efforts to identify measures that would link availability of nursing services to quality (ANA, 1997; Montalvo, 2007). Please see our, You are being redirected to Medscape Education, Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: HPV Is Probably Not at the Top of Our List. Thank you for this article. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. 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. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . 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. Often policy change involves an incremental approach that requires persistence. Nurse staffing, burnout, and health careassociated infection. (North Carolina Board of Nursing, 2019). The history of the American Nurses Association. Online Journal of Issues in Nursing, 12(3). Taylor, J. L. (2010). The statute was implemented in 2004. Medical Care, 45(12), 1195-1204. The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. You have a duty to protect the patients and the general public. 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. Effects of hospital care environment on patient mortality and nurse outcomes. 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. Board Rule 217.20 is the Board's rule concerning safe harbor nursing peer review, and 217.20(e) outlines the requirements the nurse must meet in order to secure the protections, . Nursing safe harbor is a law that nurses can use to absolve themselves of liability when forced to commit an act that the nurse believes violates Texas Board Statutes and Rules. Journal of Nursing Administration, 38(5): 223229. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. 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. Washington, DC: American Nurses Publishing. A new law in New Mexico gives nurses another option. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. We conclude by considering the common thread among these exemplars. History: . 2011 Session: A roller coaster ride for nursing. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Good luck! Name of person/supervisor (and title) making assignment or requesting the conduct: 5. Texas was the first state to have safe patient handling and movement policies enacted in legislation. General Information About Safe Harbor; The Texas Board of Nursing (BON or Board) has safe harbor nursing peer review forms available to make the process faster and easier for a nurse who believes he/she is being asked to accept an unsafe assignment, engage in conduct beyond his/her scope of practice, or engage in unprofessional or illegal conduct. Montalvo, I. Every nurse should be aware of the statutes and rules governing their profession. (2016). Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. (Eds.). For example, prior to 2019, nurses were required to invoke safe harbor in writing and notify the supervisor to receive the protections from employer discipline or board sanction. 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. The facility must have a process by which to further assess the situation. Why nurses need whistleblower protection. 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. Nurse(s) Name(s) invoking Safe Harbor: 2. 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. I work at a Childrens and Womens hospital. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Safe Harbor Forms - Nursing Peer Review. Date/Time of Request: 3. Neither are nurses legal, professional, and ethical duties. Notes on Nursing (1969 ed.). The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. How nurses advocated for their profession in the 86th legislative session. As for the two examples at the beginning, they happened and I was the nurse. She doesn't think she can provide safe care to sick neonates, and says so to the supervisor, who tells her to go to the neonatal unit anyway. The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. 192, 2011). A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. My apologies for not answering sooner. The nurse may supply supporting documents at a later time; however, the comprehensive details . Evidence-based practices for safe patient handling and movement. These challenging situations can cause mental and physical fatigue leading to moral distress. We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. Nurses have an ethical imperative to engage in policy. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy by addressing systemic barriers to optimal patient care and healthy environments through establishment of standards, regulations, and policy. For example, dissatisfied with the staffing by patient acuity model legislated in the early 1990s, (Coffman, Seago, Spetz, 2002) members of the California Nurses Association successfully pressed 164 legislators to pass a prescriptive bill specifying the maximum number of patients to be assigned to a registered nurse in each patient care area (California Assembly Bill No. As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. 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. Intended to improve the safety from physical injuries of both nurses and patients, SB 1525 was signed into law and took effect January 1, 2006. In Texas, it is called the safe harbor provision and other states, although they may not use that term, have similar policies or statutory wording. The American Nurses Association ([ANA], n.d., para. You fill out a form that basically says that your work environment is unsafe and you will continue to care for your patients to the best of your ability, but are not held responsible for mistakes that are made. 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. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. The law also allows a nurse to invoke the safe harbor when he or she questions the medical reasonableness of another healthcare provider's order that the nurse is required to execute. Initially, outcomes data related to nurse staffing was sparse. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Texas Senate Bill No. (2003). Workplace violence. It is not enough to say that we want what is best for our patients; we must also do what is best for our patients. (n.d.). Occupational injuries and illnesses among registered nurses. As gaps in protection are identified, nurses work to address them through policy change. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). Nursing workload and hospital work environment variables, including culture, have a significant impact on the ability of the nurse to provide safe and appropriate care (Kane et al., 2007; Unruh, 2008). Often policy change involves an incremental approach that requires persistence. NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. Texas House Bill No. The shortage of qualified practicing nurses is not new. American Nurses Association. Protection failures represent opportunities for future advocacy. This law requires hospitals and nursing homes to adopt policies and procedures for the safe handling of patients that control the risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. (Texas Senate Bill 1525, 2005). To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Time now is 10:30 and you just begin your med pass. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. 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. Given the outcome and scope of the outcomes of successful advocacy, and the failure to advocate discussed above, it is important to address the need for advocacy protections. The completion of this project is a great example that through the dedication and generosity of all the partners who are working together, we are succeeding in finding concrete solutions to . To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. The BON Comprehensive Written Request for Safe Harbor Nursing Peer Review Form is a sample form that may be used to document the more in-depth information that the nurse must put in writing before leaving the work setting at the end of the work period. This was the latest of many staffing incidents at this facility. This website also contains material copyrighted by 3rd parties. Advocacy in Nursing Regulation: Nurse Practice ActsThe original intent of nurse practice acts was the regulation of nursing practice through registration, now licensure (Russell, 2012). Thank you! Thank you for your comment. 476. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. B. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. The Figure offers additional information about Texas patient advocacy and whistleblower protections. 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: Example of a Safe Harbor To illustrate a safe harbor accounting method that helps a tax filer sidestep a tax regulation, assume a firm is losing money and cannot thus claim an investment. The unit also has 18 general medical beds. 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. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. The Texas Nursing Practice Actincludes several advocacy protections for nurses. For the first time, patient outcomes could be specifically mapped to nursing careBecause the NDNQI provided unit level data, it enabled comparisons across like units and like hospitals. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . 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. Texas Senate Bill No. a.cpBtn:hover {background:#666;} Nurses have been advocating for change since the day Florence Nightingale penned an urgent missive to the Secretary of State for War on the need for trained nurses to care for the wounded soldiers in the Crimea. The BON Comprehensive Written Request for Safe Harbor Nursing Peer Review Form is a sample form that may be used to document the more in-depth information that the nurse must put in writing before leaving the work setting at the end of the work period. Nurses can find themselves in all kinds or risky or potentially dangerous situations. This provision is called Safe Harbor. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. She retired from the U.S. Army in 2015 as a Lieutenant Colonel. In 2011, the Texas Emergency Nurses Association with the support of the states Nursing Legislative Agenda Coalition (a coalition of 17 nursing organizations), supported HB 703 and SB 295 which provided for enhanced criminal penalties for assaults against nurses. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Then the nursing office pulls one of the two RNs on the rest of the unit, leaving two LPNs and a tech for the 18 beds. Notify me of follow-up comments by email. Put your objections or refusal in writing. (2019). World Health Organization. https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. California Assembly Bill No. Nurses are warm, compassionate and forgiving to a fault. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Discussions of nurse staffing followed these trends. 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. Policy frames nursing practice in the most fundamental way: through state nurse practice acts (NPA) which date back over one hundred years in many states. (2011). 2022 American Nurses Association. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. While many nurses recognized the reuse practice as inconsistent with safe infection control practices, complacency among coworkers and fear of retaliation inhibited reporting of concerns. 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). Unfortunately, the significance of nurse advocacy in protecting patients from harm is perhaps best illustrated in an example in which advocacy failed and patients were harmed. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. She has practiced law in state and federal courts in Tennessee since 1996 with an interest in healthcare risk management, employment law and medical malpractice. Orthopedic Nursing, 25(6), 366-379. Nurses can invoke safe harbor, in good faith, to protect their licenses if they find themselves in compromised practice situations where it is not in the best interest of patients for them to accept an assignment, e.g. Is the assignment outside the scope of your practice or your experience and knowledge level? This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. 2410. They are not providing any cross training at all. 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. 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. or local laws, rules or regulations affecting the nurse's current area of nursing practice. This is such an unsafe situation for everyone. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. (2002). She is active in policy development, actively negotiating legislative approaches to address nursings agenda. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. a Supervisor in Kindred Hospital in West Minister California has a Habit of assigning RN to a patient in 2 different departments, So when a call light is on 1 patient , you cannot see or hear your other patient, And if refuse this assignment , you are reprimanded by your superiors, The CNA rep also has no idea to battle this on going problem. New York, NY: Little, Brown Book Group. SAFE HABOUR COMPREHENSIVE REQUEST FOR NURSING SAFE HARBOR PEER REVIEW (SHPR) ONLY SECTION I (pages 3-6) MUST BECOMPLETED BY THE NURSE WHEN INITIALLY INVOKING SAFE HARBOR A nurse's request for Safe Harbor Must be in Writing, however, use of this form is not required for a nurse to invoke Safe Harbor. I appreciate the legal advice. Further protections (Texas Occupations Code, 2019) include refusal to engage in reportable conduct; reporting staffing concerns in hospitals; nurses who refuse to engage in conduct reportable to the board of nursing; and nurse reporting of concerns within a facility about patient exposure to substantial risk of harm or failure to conform to minimum professional, regulatory, or accreditation standards. I am so sorry you are going through this. 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. Please enter a Recipient Address and/or check the Send me a copy checkbox. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. The ANA position statement is an excellent resource to start. 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. Or go, try, risk making a mistake, and hope for the best? 394. Minimum nurse-to-patient ratios in acute care hospitals in California. One of the first objectives of the new organization was the passage of legislation in 1909 requiring registration of nurses through a Board of Nurse Examiners, creating the first nurse practice act in Texas (Brown, 2010). Nurse staffing is resource intensive and is the largest component of hospital operational budgets.The complexity of nursing characteristics (e.g., skill mix); patient characteristics (e.g., acuity and case mix); and the interaction of these variables within the hospital environment make it extremely difficult to define a template as simple as a nurse-to-patient ratio to ensure appropriate staffing (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007; Unruh, 2008). Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. 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). working mandatory overtime, accepting expanded patient assignments, etc. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. What if the patient or supervisor asks a nurse 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? //Www.Ncbon.Com/Board-Information-Historical-Information, Russell, 2012 ) the committee seats are filled by direct care nurses to ensure nursing input staffing... 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