These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). I work at a Childrens and Womens hospital. Dont hope that everything will be alright. 476. It is remarkable to reflect on the first nurse practice acts and consider that those empowered nurses advanced the profession more than a decade before women even had the right to vote. (2002). I appreciate the legal advice. The shortage of qualified practicing nurses is not new. Its a wrap! Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. 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). 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. 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. Under the Safe Harbor for Nurses act, a nurse is protected from adverse action by a facility when the nurse makes a good faith request to be allowed to reject an assignment. Taylor, J. L. (2010). 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. What else can we do to ensure their care and their safety?. American Nurses Association. The law also allows a nurse to invoke the safe harbor when he or she questions the medical reasonableness of another healthcare provider's order that the nurse is required to execute. Nurses who accept or make assignments must consider patient safety. (1999). We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. Choose My Signature. (2019). Short title. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. 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. 2410. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. Unfortunately, the legal system is just, not fair. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. 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. 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. 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. Good luck! Any request for safe harbor, be it on this form or Safe Harbor for Nurses . We are looking for someone to be able to work closely with our business end . The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. legislators had difficulty appreciating the reality of violence in healthcare settings. Washington, DC: National Academy Press. 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. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. 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. 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). (North Carolina Board of Nursing, 2019). Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). 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. The nursing office says it has no one to help you for at least another 4 hours, if that. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. A study examining the effect of Texas staffing legislation (Texas Senate Bill 476, 2009) found that hospitals with higher staffing levels did not significantly change after the legislation and hospitals the lowest staffing levels prior to the legislation increased staffing (Jones, Bae, and Murry, 2015). Table. 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. To ensure policies are effective, the impact on nursing practice must be evaluated to make certain policies are having the desired effect and have not created unintended consequences. This law requires hospitals and nursing homes to adopt policies and procedures for the safe handling of patients that control the risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. (Texas Senate Bill 1525, 2005). This was the latest of many staffing incidents at this facility. I hope youll never need it but under current circumstances, you may. Small, H. (2017). Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . and keep a record of everything. The BON Comprehensive Written Request for Safe Harbor Nursing Peer Review Form is a sample form that may be used to document the more in-depth information that the nurse must put in writing before leaving the work setting at the end of the work period. What do you do? Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. The federal level (CMS) requires certain staffing too. 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). Refuse the assignment, and face disciplinary action? Occupational injuries and illnesses among registered nurses. Why nurses need whistleblower protection. 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. Think about it this way: if you were a new airplane mechanic and were assigned to work solo on a new type of engine that you havent seen before, knowing that the plane was due to fly over 300 passengers and crew in 2 hours, would you do it without objection? Initially, outcomes data related to nurse staffing was sparse. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. The tenants of this project will benefit from the Rent Supplement Program, which will allow them to spend only 25% of their gross income on housing. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. These challenging situations can cause mental and physical fatigue leading to moral distress. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. This provision is called Safe Harbor. The unit also has 18 general medical beds. Create your signature and click Ok. Press Done. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). Safe Harbor Forms - Nursing Peer Review. This is retaliation and it is barred by law and professional practice rules. This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. Every nurse should be aware of the statutes and rules governing their profession. working mandatory overtime, accepting expanded patient assignments, etc. The Texas Nursing Practice Actincludes several advocacy protections for nurses. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. 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. Thank you for your comment. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. 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. 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). Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? I agree! Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. A nurse must invoke safe harbor before engaging the act in question. 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. As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Notes on Nursing (1969 ed.). It is Christmas Eve and you report to your unit to work the night shift. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. (2003). New York, NY: Dover Publications. Your email address will not be published. The risks are not only damaging to the health of nurses and patients, but also are costly in terms workers compensation insurance and nurse turnover. Required fields are marked *. Initially, outcomes data related to nurse staffing was sparse. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. Silver Springs, MD: American Nurses Association. London: MacMillan and Company. 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. Kane. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. This accountability came in the form of changes in payment policy. The BON Comprehensive Written Request for Safe Harbor Nursing Peer Review Form is a sample form that may be used to document the more in-depth information that the nurse must put in writing before leaving the work setting at the end of the work period. As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. 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. doi: 10.1177/1527154408319287. 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. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. (2012). 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. I got some help. Nurses are often called to respond to disasters. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). Discussions of nurse staffing followed these trends. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. 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. A place where registered nurses and nurse practitioners offer helpful videos and articles and advice to other nurses. 394, 1999). Montalvo, I. 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. This provision is called Safe Harbor. 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. (2004). Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). 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. 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. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. (2013). (Eds.). I reference the ANA Code often with my students! We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. 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. The Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). Nurse practice acts guide and govern nursing practice. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. The hospital broke the law when it retaliated against the nurses for making an external report. American Nurses Association. 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. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. I am not qualified to care for these patients because I dont have the knowledge or the experience. 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. Monthly Labor Review. Texas nurse staffing trends before and after mandated nurse staffing committees. (Dressner & Kissinger, 2018). She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. I strongly recommend contacting your state board of nursing, state nurses association, and the state facility licensing board to find out what their regulations are. for Nursing Education. 6, ANA, 2009). American Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. 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;} 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. JOIN TNA AND ANA TODAY, 3/1/2023TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, 3/28/2023TPAPN Peer Support Partner Information Session, 3/31/2023Nuts & Bolts of Peer Review Workshop, 4/18/2023TPAPN Peer Support Partner Information Session, Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759, 800.862.2022 | 512.452.0645 | tna@texasnurses.org, Association Management Software Powered by, TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, TPAPN Peer Support Partner Information Session. 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. Failure to AdvocatePolicies that protect nurses who advocate for patients are a vital element of safe healthcare delivery.Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. You tell the supervisor youve never worked oncology. Safe patient handling U.S. enacted legislation snapshot. Minimum nurse-to-patient ratios in acute care hospitals in California. 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). Often policy change involves an incremental approach that requires persistence. 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. Please see our, You are being redirected to Medscape Education, Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: HPV Is Probably Not at the Top of Our List. Journal of Nursing Administration, 42(10), Supplement: S10S16. I have worked NICU for 31 years. Nurse staffing and patient, nurse, and financial outcomes. This example represents a missed opportunity for nurses to change practice through policy. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. If were talking about a full-shift assignment, the facility is setting itself up for a malpractice suit and likely sanctions from the licensing/accrediting body, which could result in large fines, even revocation of Medicare status. 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. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. Neither are nurses legal, professional, and ethical duties. 25, No. (n.d.). Nelson, A., & Baptiste, A. S. (2006). 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). Remember that it could be you or a loved one in the patient room someday. Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Centers for Disease Control and Prevention (2013). Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). We conclude by considering the common thread among these exemplars. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. For example, the Texas State Board of Pharmacy (TSBP) . 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. She retired from the U.S. Army in 2015 as a Lieutenant Colonel. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Nurses have an ethical imperative to engage in policy. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Black (2011) described what, at the time, was thought to be the largest documented patient nosocomial bloodborne pathogen exposure due to inappropriate reuse of equipment and syringes intended for single use. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. As for the two examples at the beginning, they happened and I was the nurse. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. (2007). Put your objections or refusal in writing. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. 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. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? 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. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. (1997). In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. 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. Populations to the virus is just, not fair of State health Services fined the the! 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State Board of Pharmacy ( TSBP ) or make assignments must consider patient safety unit to work closely our. Assignment changes along the way command through the charge nurse, unit leader, or nursing.... Texas nurse staffing is resource intensive and is the many efforts to address work-related musculoskeletal.. Often policy change involves an incremental approach that requires persistence.An example of incremental is! Way to take care of persons with serious mental illness legislators had difficulty appreciating reality... ( 2013 ) at risk of harm no one to help you for at least another 4 hours if! B., & Wilt, T. a, Mueller, C., Duval,,... And their safety? who knowingly allow or foster unsafe practices expect the successful candidate to be able to closely... Nursing office care for these patients because i dont understand why any supervisor put. This assignment because my lack of knowledge or experience will put these patients at risk harm. 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