Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). I had the next two days off; I interviewed at another hospital where I was immediately hired. 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. (2003). What do you do? Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. 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. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. (2019). In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. The unit also has 18 general medical beds. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). She is active in policy development, actively negotiating legislative approaches to address nursings agenda. 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. 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. 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? 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. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Licensure eligibility criteria and the first licensure exam were developed in 1904. 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. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? However, changing practice through policy does not stop with the NPA. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). After the hard work is finished and the policy becomes how we practice, the origin stories are lost, and progress is often taken for granted. How has Covid amplified issues to your culture? Protection failures represent opportunities for future advocacy. 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). 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. If you have legal questions, please speak with a licensed attorney in your area. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. This provision is called Safe Harbor. Initially, outcomes data related to nurse staffing was sparse. Texas Senate Bill No. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. Your email address will not be published. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. Click the topic below to receive emails when new articles are available. 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. She doesn't think she can provide safe care to sick neonates, and says so to the supervisor, who tells her to go to the neonatal unit anyway. Safe Harbor Forms - Nursing Peer Review. Date/Time of Request: 3. A brief history of Florence Nightingale and her real legacy, a revolution in public health. 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. 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. The Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. (2015). Texas Nursing Voice, 5(3):1, 4. Safe Harbor for Nurses . 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. The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. 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. Any request for safe harbor, be it on this form or Workplace violence. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. 16, New York companion bills A11484, A07836, S05116, and S08358. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. 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. You must declare any conflicts of interest related to your comments and responses. Washington, DC: National Academy Press. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". 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. What else can we do to ensure their care and their safety?. Texas took a slightly different approach to the problem. 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. This article is not legal advice. They are not providing any cross training at all. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. (2012). (n.d.). 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. 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. Effects of hospital care environment on patient mortality and nurse outcomes. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. 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. 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. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. 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. 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. 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. 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. 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. 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? Initially, outcomes data related to nurse staffing was sparse. We conclude by considering implications for nursing organizations and nurses among these exemplars. 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. 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. Orthopedic Nursing, 25(6), 366-379. Silver Springs, MD: American Nurses Association. 192, 2011). The relationship of nursing workforce characteristics to patient outcomes. This includes protections for whistleblowers. Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). 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. Cates, A. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. Texas Senate Bill No. Are you unqualified to care for the patients assigned? Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? 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. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. Then radiology is taking care of the patient FOR A SHORT TIME. Nurses are warm, compassionate and forgiving to a fault. For example, the Texas State Board of Pharmacy (TSBP) . 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. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} Texas was the first state to have safe patient handling and movement policies enacted in legislation. Washington, DC: American Nurses Publishing. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. Ask for help and help your colleagues when they are facing an unsafe assignment. Put your objections or refusal in writing. 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. 1, Manuscript 2. The law allows a nurse to reject an assignment on the basis of the nurse's assessment of his or her education, knowledge, competence, or experience and the nurse's immediate assessment of the risk for patient safety, or violation of the Nurse Practice Act or Board of Nursing rules. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. Texas Board of Nursing (TBON, n.d.a) clarifies Safe Harbor as a nursing peer review process the nurse may initiate, under good faith, when asked to engage in assignments or conduct the nurse believes to violate Standards of Practice, Duty to Patient, or . For the first time, patient outcomes could be specifically mapped to nursing careBecause the NDNQI provided unit level data, it enabled comparisons across like units and like hospitals. 61-3A-1. Nurses and other front-line health care works will be the most vulnerable populations to the virus. As gaps in protection are identified, nurses work to address them through policy change. Does COVID issues relates to nursing culture? Taylor, J. L. (2010). Nurse staffing, burnout, and health careassociated infection. The National Database of Nursing Quality IndicatorsTM (NDNQI). 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). Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. (2019). 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