Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. Nurse(s) Name(s) invoking Safe Harbor: 2. 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. 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. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. She has practiced law in state and federal courts in Tennessee since 1996 with an interest in healthcare risk management, employment law and medical malpractice. Nurse executives should support nurses who exercise their rights to protect their licenses and not view safe harbor requests as an affront to their leadership. 2022 American Nurses Association. Evidence-based practices for safe patient handling and movement. Historical Information. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Where creative models of care to reduce costs dominated dialogue around nurse staffing in the 1990s, attention was cued to staffing outcomes following the IOM report. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). 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. They can use a Quick Request Form from the Board of Nursings website or any document as long as it contains the following information: Nurses may not have the time or resources to properly fill out the correct form when asked to engage in an assignment that may violate Board Statutes and Rules. 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). (2019, January 30). (2012). An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. Responding to a disaster is a familiar process for several nurses in Texas. The facility may not retaliate against the nurse who invokes the safe harbor. 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. 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). The ANA position statement is an excellent resource to start. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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. When considering how to proceed in a difficult legal, ethical and professional situation, solid advice grounded in the law, which is backed by the American Nurses Association, is the best way to proceed. In Handbook of Texas Online. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. You tell the supervisor youve never worked oncology. 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. or local laws, rules or regulations affecting the nurse's current area of nursing practice. 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). Are you unqualified to care for the patients assigned? 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). They are not providing any cross training at all. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 5 pages, 2066 words 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. Minimum nurse-to-patient ratios in acute care hospitals in California. How has Covid amplified issues to your culture? Please enter a Recipient Address and/or check the Send me a copy checkbox. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. 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! 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. 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. 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. World Health Organization. Initially, outcomes data related to nurse staffing was sparse. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. I agree! Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. 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. Our hospital is expected to staff this unit. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. 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? 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. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. You not only have all 6 step-down patients, you are now charge over the other 18 beds. I am not qualified to care for these patients because I dont have the knowledge or the experience. 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. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). Safe Harbor Forms - Nursing Peer Review. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Nurses can invoke safe harbor, in good faith, to protect their licenses if they find themselves in compromised practice situations where it is not in the best interest of patients for them to accept an assignment, e.g. Examples: due to staffing and/or acuity of the patient(s). The statute was implemented in 2004. Texas House Bill No. (Eds.). Texas Nurses Association. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). Monthly Labor Review. (2019). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Successful advocacy requires the identification of concerns by individual nurses, coupled with leadership and persistence of nursing organizations with strength in numbers and a policy agenda. However, changing practice through policy does not stop with the NPA. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. Protection failures represent opportunities for future advocacy. Your license is not a free pass for employers to use you anywhere they feel a need. https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. 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. Medical Care, 45(12), 1195-1204. The ICU wants to give you a new patient and things are going from bad to worse. 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. 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. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. 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. We conclude by considering the common thread among these exemplars. 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. Nurse staffing, burnout, and health careassociated infection. Retrieved from https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, Texas Legislature Online. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Safe patient handling and mobility. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . 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. If you are a leader, do not punish the nurse objecting or refusing the assignment. Consider another situation: You are an experienced nurse. They participate in operationalizing and implementing emergency preparedness plans within their organizations, they work additional hours, they volunteer at shelters for displaced medically fragile persons, and they coordinate medical supplies, blood donations and other vital resources. The hospital broke the law when it retaliated against the nurses for making an external report. Often policy change involves an incremental approach that requires persistence. Taylor, J. L. (2010). Washington, DC: National Academy Press. Examples: due to staffing and/or acuity of the patient(s). 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. 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. We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. You will receive email when new content is published. 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. New York, NY: Dover Publications. Its a wrap! Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. RN TO FNP TRANSITION | The First 6 Months. (2007). For example, a primary care physician and a specialist to whom the . 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. 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. Please confirm that you would like to log out of Medscape. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. (2016). 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. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). Policy Politics & Nursing Practice 9(4), 274287. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. The federal level (CMS) requires certain staffing too. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. We discuss this in the context of practice in the state of Texas. In the mid- to late-1990s, the American Nurses Association (ANA) led nursing efforts to identify measures that would link availability of nursing services to quality (ANA, 1997; Montalvo, 2007). The National Database of Nursing Quality IndicatorsTM (NDNQI). Every nurse should be aware of the statutes and rules governing their profession. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. 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