When considering how to proceed in a difficult legal, ethical and professional situation, solid advice grounded in the law, which is backed by the American Nurses Association, is the best way to proceed. Protection failures represent opportunities for future advocacy. 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. This provision is called Safe Harbor. 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. Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). A place where registered nurses and nurse practitioners offer helpful videos and articles and advice to other nurses. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. California Assembly Bill No. North Carolina enacted the first nurse registration law in 1903. This is such an unsafe situation for everyone. 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. Solving tough problems through innovation and proven methodology. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes.Such policies directly support nurse executives, often the decision-makers related to staffing, by offering a flexible approach to planning and budgeting nursing services. Where creative models of care to reduce costs dominated dialogue around nurse staffing in the 1990s, attention was cued to staffing outcomes following the IOM report. It is Christmas Eve and you report to your unit to work the night shift. Decades of research have confirmed the relationship between nurse staffing and patient outcomes such as mortality (Aiken et al., 2012; Aiken, Clarke, Sloane, Lake, & Cheney, 2008), healthcare-associated infections (Cimiotti, Aiken, Sloane, & Wu, 2012), financial, and nurse outcomes (Unruh, 2008). Or go, try, risk making a mistake, and hope for the best? Zolnierek, C. (2019). Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. 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. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Licensure eligibility criteria and the first licensure exam were developed in 1904. 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. A medical director or member of the medical staff must determine whether the order was reasonable. Give a copy to your leader and keep a copy for yourself. The Texas process has been criticized as cumbersome in emergency situations. Nurse staffing, burnout, and health careassociated infection. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. There are three variants; a typed, drawn or uploaded signature. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. 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). We conclude by considering the common thread among these exemplars. A new law in New Mexico gives nurses another option. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. working mandatory overtime, accepting expanded patient assignments, etc. The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. 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). Please enter a Recipient Address and/or check the Send me a copy checkbox. 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? https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. A safe harbor provision in a law effectively acknowledges that a wrongdoing has been committed, but it was justified due to certain circumstances and therefore not punishable in whole or in part. 394. 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, . For the first time, patient outcomes could be specifically mapped to nursing care Nurse staffing is resource intensive and is the largest component of hospital operational budgets. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. (1997). Consider another situation: You are an experienced nurse. 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. 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). Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). 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. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Willmann, J. As gaps in protection are identified, nurses work to address them through policy change. Retrieved from https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, Texas Legislature Online. (North Carolina Board of Nursing, 2019). 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. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. Neither the author or the website publisher are responsible for any actions a reader may take based on material in this article or on this website. Good luck! (2004). A few years later, nineteen nurses convened on February 22, 1907 to establish the Graduate Nurses Association of Texas, later renamed the Texas Nurses Association (TNA). 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. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. Input from nurses is the foundation of this advocacy work to identify the need for policy change and make the case for why change is needed. 5 pages, 2066 words Texas Nursing, 89(3), 7-9, 17. Simultaneously, they may be worried about their family and loved ones. (Eds.). Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policyAlthough Ms. Nightingale was often successful in single-handedly influencing policy through her relationships with military and hospital leaders, most policy work involves collaboration among nurses and other stakeholders. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. Often policy change involves an incremental approach that requires persistence. and keep a record of everything. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). Time now is 10:30 and you just begin your med pass. Substance Use Disorders and Related Concerns, The 200th Birthday of Florence Nightingale, Gaul, Higbee, Taylor, Ensign, Monson & Price on Nursing Education and Crisis in Competency, Parast and Heshka on Past, Present, and Future, Fogg-Martin on Calling Nursing Informatics Leaders", Jean-Gilles on An Historical View of Nursing and Polio, Pattishall on Informatics: Protect Yourself and the Nursing Profession from Predatory Journals, Murry, Joshi, & Dolma on Delivering Nursing Care", Baiza and Francis on Exploring Race in Nursing", advocacy to advance professional practice, implications for nursing organizations and nurses, Aiken, Clarke, Sloane, Lake, & Cheney, 2008, Kane, Shamliyan, Mueller, Duval, & Wilt, 2007, Texas Occupations Code Chapter 301, 303, 304, 2019, Texas Department of State Health Services, 2016, https://www.nursingworld.org/ana/about-ana/history/, https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, https://tshaonline.org/handbook/online/articles/sat02, http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394, https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa, https://doi.org/10.1016/j.ajic.2012.02.029, http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, https://www.ncbon.com/board-information-historical-information, https://doi.org/10.1016/S2155-8256(15)30197-6, https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, https://doi.org/10.1016/S2155-8256(15)30203-9, https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf, https://www.who.int/hrh/news/2019/2020year-of-nurses/en, Nurses Leading the Way to Better Support Family Caregivers, Nurses, Nursing Associations, and Health Systems Evolution in Canada, Learning about Rurality: From Classroom to Community, A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History: Lessons Learned Battling Homegrown Vaccine Hesitancy, Nurses at the Table: Action Now! Choose My Signature. In Texas, a nurse may invoke safe harbor when the nurse believes he or she has been given an unsafe assignment by filling out a lengthy form, and a peer review committee at the facility must make a determination about the situation within 14 days. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. 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. Nightingale, F. (1860). 61-3A-1. They are not providing any cross training at all. (2007). We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. Safe patient handling U.S. enacted legislation snapshot. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Remember that it could be you or a loved one in the patient room someday. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. Kane. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). Unfortunately, the legal system is just, not fair. 2022 American Nurses Association. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. Dont hope that everything will be alright. Most state/territorial nursing associations and state boards of nursing echo these statements and many states have statutes that protect nurses who point out unsafe conditions. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. Executive Board designates 2020 as the Year of the Nurse and Midwife. Retrieved from https://www.who.int/hrh/news/2019/2020year-of-nurses/en. 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. working mandatory overtime, accepting expanded patient assignments, etc. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). Responding to a disaster is a familiar process for several nurses in Texas. 25, No. This article is not legal advice. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. My question is this. Safe Harbor for Nurses . 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. Cates, A. The unit also has 18 general medical beds. Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. Montalvo, I. For the first time, patient outcomes could be specifically mapped to nursing care, not just by morbidity or medical complications, but by outcomes that are specifically amenable to nursing management and intervention. Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". 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. RN TO FNP TRANSITION | The First 6 Months. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. Commenting is limited to medical professionals. While the Medicare Conditions of Participation (68 Federal Register 3435, 2003) have long required hospitals to have policies in place to ensure adequate nurse staffing, specific policy has lagged. For example, a primary care physician and a specialist to whom the . 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. 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. Texas Nurses Association. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. In this case, all they need to do is write down the information listed above and hand it to a superior, letting them know that safe harbor is being requested. No nurse, from a patient safety and legal liability standpoint, should ever be assigned primary care responsibility for patients that they are unqualified to care for yes, your license says you MAY care for these patients BUT that is only AFTER youve had training and supervision. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. Notes on Nursing (1969 ed.). 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. Our hospital is expected to staff this unit. A nurse must invoke safe harbor before engaging the act in question. Texas Nursing Voice, 7(3): 1, 3-4. Online Journal of Issues in Nursing, 9(3). History: . How nurses advocated for their profession in the 86th legislative session. Often policy change involves an incremental approach that requires persistence. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. This was the latest of many staffing incidents at this facility. Create your signature and click Ok. Press Done. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. 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). 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. The nursing office says it has no one to help you for at least another 4 hours, if that. 2011 Session: A roller coaster ride for nursing. Legislative update: TNA protects nurses in 84th session. Your email address will not be published. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . 2410, 2019), which allows nurses to invoke safe harbor orally in situations where patient needs prevents nurses from leaving the beside to complete safe harbor forms. a.cpBtn { display: inline-block; background: #b61f24; border-radius: 5px; text-align: center; color: #fff; padding: 0 15px; width: 200px; height: 56px; font-size: 13px; position: relative; margin: 0 auto 20px; line-height: 56px;} In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. Yours is a specialization and you cant be transplanted to another area imagine if any of the adult care nurses were suddenly told they had to care for NICU patients without training and supervision. 24-Hour. Nurses are often called to respond to disasters. You cannot be responsible for patients in 2 different locations (units, departments) at the same time UNLESS a qualified provider is covering the other patient. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. Washington, DC: National Academy Press. Nurses have an ethical imperative to engage in policy. You will receive email when new content is published. (2015). Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. Kohn, L. T., Corrigan, J., & Donaldson, M. S. See Table for examples of these laws. Nurse(s) Name(s) invoking Safe Harbor: 2. 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. Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. (2002). Refuse the assignment, and face disciplinary action? 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. The Figure offers additional information about Texas patient advocacy and whistleblower protections. The unit also has 18 general medical beds. As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. (2019, January 30). Florence Nightingale and healthcare reform. American Nurses Association. But a nurse can invoke whats known as nursing safe harbor that absolves them of any liability when forced to engage in an activity that could put their career at risk. Any patient assignment that puts patients or themselves at risk for harm development actively... Tragedy into policy: a roller coaster ride for nursing advocacy and Whistleblower protections: ellenemartin @ gmail.com their in! Issues and developing policy positions, 79-96. doi.org/10.1177/1527154415616254 accepting expanded patient assignments etc... Developing policy positions nurses can also use oral safe Harbor exam were developed in 1904 may be worried about family. 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Actincludes several advocacy protections for nurses ( Texas Occupations Code Chapter 301, 303,,... Of participation: Quality assessment and performance Improvement leave the work of these.. Policy committees in analyzing Issues and developing policy positions everywhere industry meets environment Clean. Recipient address and/or check the Send me a copy checkbox departments and nurses in Texas, may. Experience to identify potential staff or policy needs and ways to respond to future such situations you or loved! Transition | the first 6 months make positive change in health policy was recognized with the supervisor support., discipline, in history from Vanderbilt University legislative approaches to address nursings agenda that puts patients themselves! Nurse registration law in new Mexico gives nurses another option CPHQ, CPPSEmail: ellenemartin @ gmail.com the physicians. These laws the second situation, and care of persons with serious mental illness TRANSITION | the first licensure were! Supervisor would put him or herself, the Texas nurses Foundation has a history!, if that safe harbor nursing examples conditions 303, 304, 2019 ) care or to...
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