CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. (1999). 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. 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 staffing advocacy. Location of requested conduct/assignment: 4. 394, 1999). Objections must be in writing so check to see if your facility or state has a form and keep several blank copies in your locker or backpack. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. Commenting is limited to medical professionals. But what if the patient or their supervisor asks them to do something that would violate Board Statutes and Rules, such as falsifying medical records, performing a procedure that could harm the patient, or even assisting in criminal activity? (2004). Time now is 10:30 and you just begin your med pass. Often policy change involves an incremental approach that requires persistence. 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. A nurse must invoke safe harbor before engaging the act in question. Although the organizational policy changes that result from implementation of grant programs may help protect the nurses who work the facilities awarded grant funds, widespread protections remain elusive despite a decade of advocacy. 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. What do you do? Required fields are marked *. 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. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. This includes protections for whistleblowers. Examples: due to staffing and/or acuity of the patient(s). This assistance is covered by the SHQ (90%) and the City of Montral . Dont hope that everything will be alright. 394. The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. Neither are nurses legal, professional, and ethical duties. 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. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Initially, outcomes data related to nurse staffing was sparse. Texas Senate Bill No. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. When you arrive for the day shift, you have a full house and you discover that one of the two step-down nurses is out sick. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. Protection failures represent opportunities for future advocacy. I agree! The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. doi: 10.1177/1527154408319287. 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. 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. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. The facility may not retaliate against the nurse who invokes the safe harbor. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. 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. You not only have all 6 step-down patients, you are now charge over the other 18 beds. In Handbook of Texas Online. Nurses dont always have a lot of authority on the floor, so they need to learn how to protect themselves if someone asks them to do something that goes against their ethics or the law. The Texas law applies to employers of eight or more nurses. With the increasing body of evidence documenting the relationship between nurse staffing and patient outcomes, several states have passed legislation requiring organizations to adopt more specific policies and practices. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. It is Christmas Eve and you report to your unit to work the night shift. Texas Nursing Voice, 7(3): 1, 3-4. In 2011, the Texas Emergency Nurses Association with the support of the states Nursing Legislative Agenda Coalition (a coalition of 17 nursing organizations), supported HB 703 and SB 295 which provided for enhanced criminal penalties for assaults against nurses. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. As gaps in protection are identified, nurses work to address them through policy change. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Consider another situation: You are an experienced nurse. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Solving tough problems through innovation and proven methodology. When you get to the unit, the charge nurse gives you a fast report on your assigned patients. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. The unit also has 18 general medical beds. 192, 2011). Give a copy to your leader and keep a copy for yourself. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. Willmann, J. Small, H. (2017). Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. Texas Nursing, 89(3), 7-9, 17. (2015). In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. The facility must have a process by which to further assess the situation. 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. 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. Online Journal of Issues in Nursing, 12(3). American Nurses Association. 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. An existing policy of enhanced criminal penalties for assaults against first responders, such as peace officers, firefighters, and emergency medical service workers (which elevated the seriousness of the offense from a misdemeanor to a felony) inspired a similar approach to deter violence against nurses. Journal of Nursing Administration, 42(10), Supplement: S10S16. These challenging situations can cause mental and physical fatigue leading to moral distress. 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. Nurses have an ethical imperative to engage in policy. A brief history of Florence Nightingale and her real legacy, a revolution in public health. 5 pages, 2066 words 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? Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. Your email address will not be published. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). 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. 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. Brief explanation of why invoking Safe Harbor (It may be helpful to review rules 217.11 and 217.12): Signature(s) of Nurse(s) Invoking Safe Harbor: Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. Remember that it could be you or a loved one in the patient room someday. Beth J. Nelson, A., & Baptiste, A. S. (2006). Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. 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. RN TO FNP TRANSITION | The First 6 Months. Decide on what kind of signature to create. 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. What do you do? We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. 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. Texas Nursing Voice, 5(3):1, 4. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. Are you unqualified to care for the patients assigned? Does COVID issues relates to nursing culture? Safe patient handling U.S. enacted legislation snapshot. 2410. Texas was the first state to have safe patient handling and movement policies enacted in legislation. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. (15) Safe Harbor--A process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good . and keep a record of everything. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. Texas Senate Bill No. Nurses are warm, compassionate and forgiving to a fault. most policy work involves collaboration among nurses and other stakeholders.Nursing practice is regulated at the state level, therefore most of the exemplars in this article are from Texas, our state. 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). Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. 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. 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. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. 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. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. 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. Unfortunately, the significance of nurse advocacy in protecting patients from harm is perhaps best illustrated in an example in which advocacy failed and patients were harmed. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. working mandatory overtime, accepting expanded patient assignments, etc. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. Both professional nursing organizations, and individual nurses, must continue advocacy at all levels. 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. To err is human: Building a safer health system. 61-3A-1. 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. 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. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. 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. Given the outcome and scope of the outcomes of successful advocacy, and the failure to advocate discussed above, it is important to address the need for advocacy protections. Nurses can find themselves in all kinds or risky or potentially dangerous situations. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. 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 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. (2015). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. A safe harbor provision in a law effectively acknowledges that a wrongdoing has been committed, but it was justified due to certain circumstances and therefore not punishable in whole or in part. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. (2019, January 30). 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. (2019). 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. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. 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. Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. 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). History: . Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. 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. This example represents a missed opportunity for nurses to change practice through policy. 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. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. 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. Choose My Signature. (2016). 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). New York, NY: Dover Publications. Nightingale, F. (1860). 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). 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. You submit it to the BON. Washington, DC: American Nurses Publishing. 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. 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. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). To help nurses better understand when to invoke safe harbor, the Board of Nursing lists the following types of situations in which safe harbor may be applied: Nurses should be aware of their rights on the floor, including their ability to refuse a request or invoke safe harbor when they feel that such a request would put their job on the line. I am not qualified to care for these patients because I dont have the knowledge or the experience. 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. 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. Kohn, L. T., Corrigan, J., & Donaldson, M. S. Policy Politics & Nursing Practice 9(4), 274287. They are not providing any cross training at all. If you log out, you will be required to enter your username and password the next time you visit. Im in the first stages of getting into nursing school and this article basically sums up my concerns and addresses them exactly! Short title. 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. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. 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). 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. Licensure eligibility criteria and the first licensure exam were developed in 1904. Protections are imperfect, but that does not diminish their importance. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. 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). Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). We then 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. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. Texas was the first state to have safe patient handling and movement policies enacted in legislation. Workplace violence. I work at a Childrens and Womens hospital. If you dont have your own malpractice/professional liability insurance, you should invest in coverage immediately because the facility will likely try to shift blame for any patient injuries or deaths to the individual nurse. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. Please confirm that you would like to log out of Medscape. 1525. California Assembly Bill No. (2009). Discussions of nurse staffing followed these trends. 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). 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. Legislative update: TNA protects nurses in 84th session. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. 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. 476. I appreciate the legal advice. 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. When you arrive for the day shift, you have a full house and you discover that one of the two step-down nurses is out sick. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. 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. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). 192: Section 301.413(b-1). 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. 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. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. Orthopedic Nursing, 25(6), 366-379. A joint investigation by federal and state agencies revealed violation of standard infection control practices. Ask for help and help your colleagues when they are facing an unsafe assignment. A nurse may invoke safe harbor to err on the side of caution whenever they feel that their actions as requested by a patient or supervisor may violate Board Statures and Rules. The Year of the nurse-as-advocate role, added in 1976 protect nurses who advocate for patients assigned to RN..., do general basic nursing care ; the regular staff nurses will handle everything else document carefully use!, A., & nurse licensure Compact: Texas Occupations Code one in healthcare! 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