Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. (2002). I am so sorry you are going through this. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. Nightingale, F. (1860). 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). How has Covid amplified issues to your culture? You have a duty to protect the patients and the general public. (2019). Thank you for your comment. This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. Recently our hospital has opened an adult unit as an overflow from the University hospital. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. 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 was the latest of many staffing incidents at this facility. You've successfully added to your alerts. Commenting is limited to medical professionals. This provision is called Safe Harbor. Texas Nurses Association. A., & Spetz, J. A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. 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 relationship of nursing workforce characteristics to patient outcomes. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). 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). Retrieved from https://www.nursingworld.org/ana/about-ana/history/. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Examples: due to staffing and/or acuity of the patient(s). However, we recognize that there are stories from every state that highlight the valuable work of many nurses that illustrate individual and collective nursing organization advocacy. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. 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. This database includes measures directly related to nursing care and patient outcomes (Montalvo, 2007) such as: nursing hours per patient days; hospital-acquired infections and pressure ulcers; and skill mix (percent of total nursing hours supplied by different types of direct care providers). Nightingale, F. (1914). 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. We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. In addition, the ANAs Code of Ethics for Nurses (2001) spells out the RNs accountability for judgments made and actions taken in the course of nursing practice, irrespective of health care organizations policies or providers directives, (Provision 4). 1, Manuscript 2. Oncologist Files Whistleblower Lawsuit Against Roswell Park, Patient Safety in Hospitals Improved in Past Decade: Report, COVID-19 Dominates Annual List of Patient Safety Concerns, Artificial Sweetener in 'Keto Foods' Tied to Cardiovascular Risk, The Safety of Anticoagulants and Antiplatelet Agents in Patients With Cirrhosis, A Nuanced Look at Biologic Therapies in Moderate to Severe Plaque Psoriasis, Trending Clinical Topics for February 2019, Alcohol, Melatonin, and Other Top Clinical Topics of 2022, EMA Panel Recommends DPD Testing Prior to Fluorouracil Treatment, Advances in Chronic Kidney Disease Care in Type 2 Diabetes, Modified ECT Lowers Dental, Skeletal Fracture Risk. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. As gaps in protection are identified, nurses work to address them through policy change.As gaps in protection are identified, nurses work to address them through policy change. The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. We offer exemplars that illustrate policies that regulate the environment of practice, such as nurse staffing, musculoskeletal injury prevention, and failure to advocate, and discuss needed protections, including whistleblower protections in our state. Zolnierek, C. (2019). Please enter a Recipient Address and/or check the Send me a copy checkbox. Workplace violence study. 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. 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. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). 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. Code of ethics with interpretive statements. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. 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. I am not qualified to care for these patients because I dont have the knowledge or the experience. 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). In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports.Nurses know that a culture supporting collaborative, interdisciplinary practice that encourages both identification and reporting of problems and barriers to care delivery leads to optimum patient and nurse outcomes. The unit also has 18 general medical beds. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. 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. (2007). (2015). (Eds.). To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Texas nurse staffing trends before and after mandated nurse staffing committees. 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. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. Unfortunately, many nurses and many leaders will answer the question with some form of suck it up and do the best you can. And while I know that questioning an assignment, let alone refusing it, is hard, this is exactly what you must consider doing. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Protection failures represent opportunities for future advocacy. (2019). Please confirm that you would like to log out of Medscape. Then radiology is taking care of the patient FOR A SHORT TIME. During disaster situations, nurses often find themselves dealing with the challenges of potentially undesirable outcomes of providing care in compromised environments with lack of staff or supplies. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . 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. Licensure eligibility criteria and the first licensure exam were developed in 1904. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). Initially, outcomes data related to nurse staffing was sparse. ISSN: 1091-3734 American Nurses Association - 8515 Georgia Avenue - Suite 400 - Silver Spring, MD 20910, Susan C. Reinhard, RN, PhD, FAAN; Andrea Brassard, PhD, FNP-BC, FAAN, Michael Villeneuve, MSc, RN, FAAN ; Claire Betker, PhD, MN, RN, CCHN(C), Ruth Mielke, PhD, CNM, FACNM, WHNP-BC; Sue Robertson, PhD, RN; Juliana van Olphen Fehr, CNM, PhD, FACNM, Sofia A. Aragon, JD, BSN, RN; Gerianne M. Babbo, EdD, MN, RN; Sarah J. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. To err is human: Building a safer health system. Why nurses need whistleblower protection. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. New York, NY: Dover Publications. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). What else can we do to ensure their care and their safety?. Orthopedic Nursing, 25(6), 366-379. 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. I have worked NICU for 31 years. We discuss this in the context of practice in the state of Texas. Its a wrap! NPAs have not remained stagnant over the past century, rather they have evolved but only with the active involvement of nurses in legislative efforts to change statute and update policies related to nursing practice. A nurse must invoke safe harbor before engaging the act in question. 16, New York companion bills A11484, A07836, S05116, and S08358. 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 legal system is just, not fair. Table. Since then, 11 states have either passed laws or promulgated regulations, 10 of which require healthcare facilities to develop and implement comprehensive safe patient handling programs (Brigham, 2015). Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. However, there is a large majority who have never experienced working in disaster situations such as hurricanes, mass shootings, or disease outbreaks and therefore may not be aware of their role in the emergency preparedness process and what they can do for themselves. This example represents a missed opportunity for nurses to change practice through policy. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. For a nurse like me who has zero adult experience can I be forced to take care of these patients? Solving tough problems through innovation and proven methodology. 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. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. 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. Examples: due to staffing and/or acuity of the patient(s). I am concerned for the patients safety and I need your help to find a safer way to take care of these patients. I cannot accept this assignment because my lack of knowledge or experience will put these patients at risk of harm. (2007). 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. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} For example, the Texas State Board of Pharmacy (TSBP) . (Read the story of how one nurse worked through TNA to make this possible.). The Texas Nursing Practice Actincludes several advocacy protections for nurses. Texas Senate Bill No. The federal level (CMS) requires certain staffing too. Share cases and questions with Physicians on Medscape Consult. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. 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. 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. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. In Handbook of Texas Online. (2015). Safe patient handling and mobility. This is retaliation and it is barred by law and professional practice rules. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. 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. American Nurses Association. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". Washington, DC: National Academy Press. A brief history of Florence Nightingale and her real legacy, a revolution in public health. She received a BSN from University of Detroit – Mercy, magna cum laude, an MSN in adult psychiatric-mental health nursing from Wayne State University, and a PhD in nursing from University of Texas at Austin where she was recognized as the outstanding doctoral student. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. Board of nursing rules outline the procedures nurses must follow to access these protections. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. The facility may not retaliate against the nurse who invokes the safe harbor. 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. We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. a.cpBtn:hover {background:#666;} 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. and keep a record of everything. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . 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). Insurance companies pay the price for HAIs. 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. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. Nurses can find themselves in all kinds or risky or potentially dangerous situations. The statute was implemented in 2004. 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. By mid-morning, you have two disoriented step-down patients, including one who pulls out his IV and fights with his family, and your LPNs cant give IV meds. Nurses are often called to respond to disasters. 1525. Often policy change involves an incremental approach that requires persistence. The nursing office says it has no one to help you for at least another 4 hours, if that. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Remember that it could be you or a loved one in the patient room someday. It is one thing to have patients on a unit and one goes to radiology. Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. Beth J. 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 . 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. Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). (2016). Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. 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. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. 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). 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. 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. You not only have all 6 step-down patients, you are now charge over the other 18 beds. The National Database of Nursing Quality IndicatorsTM (NDNQI). Consider another situation: You are an experienced nurse. 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. Or go, try, risk making a mistake, and hope for the best? 2011 Session: A roller coaster ride for nursing. This is such an unsafe situation for everyone. 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). 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. Date/Time of Request: 3. This encompasses a wide range of potentially dangerous situations and criminal activity, including tampering with medical records, putting the patient, the nurse or another persons life in danger, or committing a crime of some sort. (2003). I appreciate the legal advice. 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. Thank you so much for this article! Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). (1999). They are at the service of the patient and the doctor or another medical supervisor. 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. 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. 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. During the most recent legislative session, TNA leaders negotiated bill language with the Texas Hospital Association that would have required workplace violence prevention plans with input from direct care nurses. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. 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. 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. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. Employer retaliation, suspension, termination, safe harbor nursing examples, a postoccurrence review of the situation, can... To discipline you education was an important component of early nursing regulation (,! 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