Kane. 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. 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. Decades of research have confirmed the relationship between nurse staffing and patient outcomes such as mortality (Aiken et al., 2012; Aiken, Clarke, Sloane, Lake, & Cheney, 2008), healthcare-associated infections (Cimiotti, Aiken, Sloane, & Wu, 2012), financial, and nurse outcomes (Unruh, 2008). A joint investigation by federal and state agencies revealed violation of standard infection control practices. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. A medical director or member of the medical staff must determine whether the order was reasonable. 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. 394. Required fields are marked *. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. 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. The unit also has 18 general medical beds. However, changing practice through policy does not stop with the NPA. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 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. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. Or go, try, risk making a mistake, and hope for the best? We discuss this in the context of practice in the state of Texas. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. 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. It is offered only as information about nursing topics of interest. Please confirm that you would like to log out of Medscape. 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). Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. 2011 Session: A roller coaster ride for nursing. Date/Time of Request: 3. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. (2007). Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. 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. Evidence-based practices for safe patient handling and movement. California Assembly Bill No. The Texas law applies to employers of eight or more nurses. Invoking safe harbor shouldn't change anything. (2015). Workplace violence. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. 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. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. The American Nurses Association ([ANA], n.d., para. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. SAFE HABOUR COMPREHENSIVE REQUEST FOR NURSING SAFE HARBOR PEER REVIEW (SHPR) ONLY SECTION I (pages 3-6) MUST BECOMPLETED 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. Monthly Labor Review. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Thank you so much for this article! 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. 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? Texas Senate Bill No. New York, NY: Dover Publications. Why nurses need whistleblower protection. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. 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. Workplace violence study. Neither the author or the website publisher are responsible for any actions a reader may take based on material in this article or on this website. (2002). 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. Policy Politics & Nursing Practice 9(4), 274287. Nurses can find themselves in all kinds or risky or potentially dangerous situations. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. (2019). Examples: due to staffing and/or acuity of the patient(s). Decide on what kind of signature to create. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. 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. My apologies for not answering sooner. 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. I appreciate the legal advice. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. Its a wrap! 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. 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. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. The Texas process has been criticized as cumbersome in emergency situations. (2005). Insurance companies pay the price for HAIs. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. 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She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). This example represents a missed opportunity for nurses to change practice through policy. This is such an unsafe situation for everyone. Safe patient handling and mobility. 5 pages, 2066 words doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). 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. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. Nursing workload and hospital work environment variables, including culture, have a significant impact on the ability of the nurse to provide safe and appropriate care (Kane et al., 2007; Unruh, 2008). 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). Texas Nursing Voice, 7(3): 1, 3-4. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Washington, DC: National Academy Press. 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. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? I hope youll never need it but under current circumstances, you may. 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. A brief history of Florence Nightingale and her real legacy, a revolution in public health. American Nurses Association. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. working mandatory overtime, accepting expanded patient assignments, etc. It is Christmas Eve and you report to your unit to work the night shift. Texas Nursing, 89(3), 7-9, 17. 2410. Historical Information. I work at a Childrens and Womens hospital. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). 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. Thank you for your comment. 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. 2022 American Nurses Association. 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). Online Journal of Issues in Nursing, 9(3). What do you do? (2019). That is something you need to address with your risk manager AND absolutely worth a phone call to your state board of nursing for their guidance. This is retaliation and it is barred by law and professional practice rules. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Even if you have never been in questionable situation, you should know your organizations policies and your states laws and regulations regarding refusing an assignment. Nurse practice acts guide and govern nursing practice. 6, ANA, 2009). (2009). These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. 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. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? and keep a record of everything. 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. 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. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. We conclude by considering implications for nursing organizations and nurses among these exemplars. 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. B. 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! 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