(Read the story of how one nurse worked through TNA to make this possible.). (2002). 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. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. A brief history of Florence Nightingale and her real legacy, a revolution in public health. Time now is 10:30 and you just begin your med pass. 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. Journal of Nursing Administration, 42(10), Supplement: S10S16. (2011). This accountability came in the form of changes in payment policy. Good luck! The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Safe Harbor Forms - Nursing Peer Review. The National Database of Nursing Quality IndicatorsTM (NDNQI). 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. If you have legal questions, please speak with a licensed attorney in your area. You tell the supervisor youve never worked oncology. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Kohn, L. T., Corrigan, J., & Donaldson, M. S. 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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. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. This article is not legal advice. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. 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). Safe patient handling and mobility. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. 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. 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. 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. 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. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). Name of person/supervisor (and title) making assignment or requesting the conduct: 5. 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? Good luck! Policy Politics & Nursing Practice 9(4), 274287. 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. Both professional nursing organizations, and individual nurses, must continue advocacy at all levels. For example, the Texas State Board of Pharmacy (TSBP) . London: MacMillan and Company. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Required fields are marked *. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. 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. (2015). In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. Nurses can find themselves in all kinds or risky or potentially dangerous situations. I hope youll never need it but under current circumstances, you may. COMPREHENSIVE REQUEST FOR NURSING SAFE HARBOR PEER REVIEW (SHPR) NOTE: ONLY SECTION I (pages 3-6) MUST BE COMPLETED 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. California Assembly Bill No. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. Then radiology is taking care of the patient FOR A SHORT TIME. 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). History: . 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. 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. legislators had difficulty appreciating the reality of violence in healthcare settings.The compelling study results were published in 2016 (Texas Department of State Health Services, 2016) and the data supported efforts to pass legislation (HB 280) that funded grants for innovative approaches to reduce workplace violence in health care organizations. 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. Beth J. Licensure eligibility criteria and the first licensure exam were developed in 1904. (2003). 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. Is the assignment outside the scope of your practice or your experience and knowledge level? Examples: due to staffing and/or acuity of the patient(s). This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. 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. Protection failures represent opportunities for future advocacy. Consider another situation: You are an experienced nurse. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. We conclude by considering implications for nursing organizations and nurses among these exemplars. 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. 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. You've successfully added to your alerts. Although both bills failed to pass in 2011 (Willmann, 2011), similar legislation enhancing penalties for assault of emergency department personnel passed in the next legislative session (Willmann, 2013). Nurses are often called to respond to disasters. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). 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. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Online Journal of Issues in Nursing, 12(3). Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. (2000). Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. RN TO FNP TRANSITION | The First 6 Months. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 394, 1999). Protections are imperfect, but that does not diminish their importance. (2016). Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. The Texas Nursing Practice Actincludes several advocacy protections for nurses. (2011). After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. Short title. 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. A., & Spetz, J. Washington, DC: National Academy Press. Nurses are warm, compassionate and forgiving to a fault. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. 6, ANA, 2009). In 2019, legislation supported by NLAC as well as the Texas Hospital Association was proposed to establish Violence Prevention Committees within healthcare organizations (HB 2980); the effort failed (Zolnierek, 2019). 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. 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. (n.d.). Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). Registered nurses experience musculoskeletal injuries at a rate of 46.0 cases per 10,000 full-time workers, much higher than the rate for all occupations, 29.4 cases per 10,000 workers based on data from the U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses. 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. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). 2410. 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. I got some help. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. 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). This includes protections for whistleblowers. 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. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. Nurse staffing and patient, nurse, and financial outcomes. Thank you for your comment. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. 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. 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. You submit it to the BON. It is one thing to have patients on a unit and one goes to radiology. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). (2013). 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. Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. New York, NY: Dover Publications. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. 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