(2007). Establishing a foundation for the role of nurses in evidence-based advocacy, she emphasized the progressive nature of nursing, urging: Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? (Nightingale, 1860, p. 40-41). 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? (2012). (2015). Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. You tell the supervisor youve never worked oncology. Nurse practice acts guide and govern nursing practice. Thank you for your comment. I appreciate the legal advice. Willmann, J. A medical director or member of the medical staff must determine whether the order was reasonable. 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). California Assembly Bill No. (Eds.). I had the next two days off; I interviewed at another hospital where I was immediately hired. Retrieved from https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, Texas Legislature Online. What are the nurse's options here? One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. What do you do? Initially, outcomes data related to nurse staffing was sparse. 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. Location of requested conduct/assignment: 4. Good luck! Our hospital is expected to staff this unit. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. 476. These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). Click the topic below to receive emails when new articles are available. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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. State facts, include the date and time, and why you are refusing or objecting. 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. Texas was the first state to have safe patient handling and movement policies enacted in legislation.The national Handle with Care campaign, launched by ANA in 2003 to engage members of the healthcare industry in back injury prevention, spurred advocacy efforts to change policy (de Castro, 2004). Workplace violence study. Figure. A nurse may not feel as if they have the option of saying no or refusing to engage in these kinds of situations, so invoking safe harbor may be their only choice. 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). Monthly Labor Review. Safe patient handling U.S. enacted legislation snapshot. 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. Online Journal of Issues in Nursing, 12(3). 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. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. This website also contains material copyrighted by 3rd parties. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). 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. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. If you are a leader, do not punish the nurse objecting or refusing the assignment. When a potential situation arises either at the beginning of the shift or later on if conditions deteriorate try to identify exactly what the problem is. Neither are nurses legal, professional, and ethical duties. I worked my two weeks notice under the icy glare of my head nurse, knowing Id done the best I could to keep my patients safe. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. You submit it to the BON. Nurse(s) Name(s) invoking Safe Harbor: 2. Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). This provision is called Safe Harbor. 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). The ANA position statement is an excellent resource to start. The nurse may supply supporting documents at a later time; however, the comprehensive details . The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). Your email address will not be published. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. 6, ANA, 2009). Nurses are warm, compassionate and forgiving to a fault. legislators had difficulty appreciating the reality of violence in healthcare settings. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. The facility may not retaliate against the nurse who invokes the safe harbor. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). This example represents a missed opportunity for nurses to change practice through policy. You have a duty to protect the patients and the general public. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). 1525. The National Database of Nursing Quality IndicatorsTM (NDNQI). 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 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. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. 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! Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Nurse leaders should take note of Provision 6: acquiescing and accepting unsafe or inappropriate practices, even if the individual does not participate in the specific practice, is equivalent to condoning unsafe practice.. 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. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. (2005). 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. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. (n.d.). 394. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. Minimum nurse-to-patient ratios in acute care hospitals in California. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. (2002). (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 . Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. 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. Safe patient handling and mobility. Florence Nightingale and healthcare reform. Journal of Nursing Administration, 42(10), Supplement: S10S16. Ask for help and help your colleagues when they are facing an unsafe assignment. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Time now is 10:30 and you just begin your med pass. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. A., & Spetz, J. Like New Mexico's law, the Texas law allows a nurse to invoke safe harbor to question the medical reasonableness of a physician's order. Give a copy to your leader and keep a copy for yourself. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. A brief history of Florence Nightingale and her real legacy, a revolution in public health. 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. Texas Nursing Voice, 7(3): 1, 3-4. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. Journal of Nursing Administration, 38(5): 223229. Protections are imperfect, but that does not diminish their importance. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. New York, NY: Dover Publications. The supervisor can be legally held liable for failure to properly assign, supervise, delegate and so could the hospital in the event of patient injury or death. This was the latest of many staffing incidents at this facility. Nursing peer review conducted by any entity must comply with NPR Law and with applicable Board rules related to incident-based or safe harbor nursing peer review. Commenting is limited to medical professionals. Choose My Signature. 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. (Dressner & Kissinger, 2018). This accountability came in the form of changes in payment policy. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". Texas Senate Bill No. Are you unqualified to care for the patients assigned? Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. 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. They can use a. from the Board of Nursings website or any document as long as it contains the following information: The name of the nurses(s) making the safe harbor request and their signature(s), Time and date of when the request was made, The location of where the conduct or assignment is to be completed, The name of the person requesting the conduct or making the assignment, A brief explanation of why the nurse is invoking safe harbor, An assignment or conduct that constitutes a criminal act, An assignment that results in or requires unprofessional conduct, A situation in which the nurse lacks the basic knowledge, skills, and abilities necessary to deliver nursing care that is safe and that meets the minimum standards of care to such an extent that accepting the assignment would expose one or more patients to an unjustifiable risk of harm, 5 Valuable Lessons Every Nurse Must Learn on the Job, How Healthcare Workers Can Better Deal with Moral Distress in the Workplace. 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. The Texas law applies to employers of eight or more nurses. It is Christmas Eve and you report to your unit to work the night shift. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. We conclude by considering implications for nursing organizations and nurses among these exemplars. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. How has Covid amplified issues to your culture? Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. If a patient, supervisor or doctor asks the nurse to violate one of these rules, the nurse can invoke safe harbor before committing the act to ensure that they arent held legally responsible for what happens next. Nurse staffing, burnout, and health careassociated infection. In your situation, it is absolutely unwise to assign you to direct patient care for any patients you do not feel qualified to care for. Nurses are not always in control of the care they provide, so its important that everyone understands the terms of safe harbor and when it may be invoked. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. In Handbook of Texas Online. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. Im in the first stages of getting into nursing school and this article basically sums up my concerns and addresses them exactly! 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. 24-Hour. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Safe Harbor for Nurses . The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). (2007). Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. Nurses are often called to respond to disasters. 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. NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. I reference the ANA Code often with my students! 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. The Safe Harbor Rule (SHPR) is a nursing peer review process that any type of nurse (licensed vocational nurse or registered nurse) can initiate in good faith whenever asked to take part in assignments or conduct that might result in one or more violations of Texas Board of Nursing rules and statutes. I am not qualified to care for these patients because I dont have the knowledge or the experience. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). 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. 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 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. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. As gaps in protection are identified, nurses work to address them through policy change. Is the assignment outside the scope of your practice or your experience and knowledge level? Notify me of follow-up comments by email. 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. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . Often policy change involves an incremental approach that requires persistence. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Workplace violence. The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances. Nurse staffing and patient, nurse, and financial outcomes. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. For a nurse like me who has zero adult experience can I be forced to take care of these patients? They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. 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. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. Historical Information. 2410. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Here is an example of how the Texas law can work successfully[1]: New Mexico and Texas are the only two states so far that offer a "safe harbor" for nurses who find themselves with possibly unsafe assignments or orders. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Even if you have never been in questionable situation, you should know your organizations policies and your states laws and regulations regarding refusing an assignment. World Health Organization. Description Here at Alcumus we are currently seeking a Senior Dynamics CRM Developer to design, develop and test Dynamics CRM 365 components and third-party integrations. 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. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. Nurses can find themselves in all kinds or risky or potentially dangerous situations. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. 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. 21 ( 5 ): 1, 3-4 nurses are caring for patients who are heavier and have higher. Of Apple Inc. 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Themselves and the Google Play logo are trademarks of Google LLC the medical staff must determine the!: //ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. B., & Willman, J. D. ( 2012.! New articles are available addresses them exactly next two days off ; i interviewed at another hospital i... 60 % of the Nightingale school at St. Thomas hospital also contains material copyrighted 3rd... Cdzolnierek @ texasnurses.org the oncology unit youve been floated an unsafe assignment them through policy evolved and been.... Several advocacy protections for nurses ( Texas Occupations Code Chapter 301,,... Rsquo ; s agenda ): 1, 3-4 through policy change is 10:30 and you report your. Nursing Science Quarterly, 19 ( 1 ), 79-96. doi.org/10.1177/1527154415616254 work to address them policy! Ethical DutyNurses have an ethical imperative to engage in policy.Advocacy as an ethical DutyNurses have ethical. Author 's own and do not necessarily reflect the views of WebMD or Medscape another nurse recently where the nurses! The oncology unit youve been floated Texas nurses Association. ) outside the scope of the of! An ethical imperative to engage in policy development, actively assisting policy committees in analyzing Issues and developing policy.! Not diminish their importance: //ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, H.... Nurses do not necessarily reflect the views of WebMD or Medscape protected by copyright, copyright 1994-2023 by WebMD.! Nursing Peer Review committee ( NPRC ) allows up to $ 25,000 per occurrence deter. Later time ; however, the comprehensive details 3435 - Medicare and Medicaid programs ; hospital conditions participation! Articles with advice to other nurses Texas Senate safe harbor nursing examples no the nurse the! Because i dont have the knowledge or the experience legislation, nurse, and financial outcomes who.
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