While the Medicare Conditions of Participation (68 Federal Register 3435, 2003) have long required hospitals to have policies in place to ensure adequate nurse staffing, specific policy has lagged. The ICU wants to give you a new patient and things are going from bad to worse. (2016). The nurse may supply supporting documents at a later time; however, the comprehensive details . Is the assignment outside the scope of your practice or your experience and knowledge level? 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Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent.In sum, the need for evaluation of policies is vital. A nurse must invoke safe harbor before engaging the act in question. 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). Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. 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. 2410. The Texas process has been criticized as cumbersome in emergency situations. (n.d.). What else can we do to ensure their care and their safety?. 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. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. I appreciate the legal advice. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. working mandatory overtime, accepting expanded patient assignments, etc. 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. 192, 2011). This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. (2002). 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. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). Texas Nursing Voice, 5(3):1, 4. Often policy change involves an incremental approach that requires persistence. Good luck! Because she was in the middle of a procedure, she could not leave the patients bedside to invoke safe harbor in writing as required by existing law. 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. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy by addressing systemic barriers to optimal patient care and healthy environments through establishment of standards, regulations, and policy. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. Put your objections or refusal in writing. 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. Table. I am not qualified to care for these patients because I dont have the knowledge or the experience. 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. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Texas was the first state to have safe patient handling and movement policies enacted in legislation. 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. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. (2015). 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. 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. 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. 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. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). It is one thing to have patients on a unit and one goes to radiology. 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. 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. You must declare any conflicts of interest related to your comments and responses. Commenting is limited to medical professionals. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). For example, the Texas State Board of Pharmacy (TSBP) . This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. 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). Board Rule 217.20 is the Board's rule concerning safe harbor nursing peer review, and 217.20(e) outlines the requirements the nurse must meet in order to secure the protections, . Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. 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. History: . In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. 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). (2013). Simultaneously, they may be worried about their family and loved ones. Your email address will not be published. Invoking safe harbor shouldn't change anything. Online Journal of Issues in Nursing, 12(3). 476. 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. In Texas, it is called the safe harbor provision and other states, although they may not use that term, have similar policies or statutory wording. 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. There are three variants; a typed, drawn or uploaded signature. working mandatory overtime, accepting expanded patient assignments, etc. North Carolina enacted the first nurse registration law in 1903. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. 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. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. The profession of nursing has changed significantly in the 160 years since Florence Nightingales day, but her words still ring true today, Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back (Nightingale, 1914, p. 1). Choose My Signature. Your email address will not be published. Examples: due to staffing and/or acuity of the patient(s). Safe patient handling U.S. enacted legislation snapshot. Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . Unfortunately, many nurses and many leaders will answer the question with some form of suck it up and do the best you can. And while I know that questioning an assignment, let alone refusing it, is hard, this is exactly what you must consider doing. This assistance is covered by the SHQ (90%) and the City of Montral . We conclude by considering the common thread among these exemplars. New Mexico's law was inspired by a Texas law. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. 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. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. 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. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. for Nursing Education. (2012). Consider another situation: You are an experienced nurse. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. 61-3A-1. For example, dissatisfied with the staffing by patient acuity model legislated in the early 1990s, (Coffman, Seago, Spetz, 2002) members of the California Nurses Association successfully pressed 164 legislators to pass a prescriptive bill specifying the maximum number of patients to be assigned to a registered nurse in each patient care area (California Assembly Bill No. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. 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;} Share cases and questions with Physicians on Medscape Consult. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. Required fields are marked *. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Historical Information. Zolnierek, C. (2019). Policy Politics & Nursing Practice 9(4), 274287. If you are a leader, do not punish the nurse objecting or refusing the assignment. As for the two examples at the beginning, they happened and I was the nurse. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. I worked my two weeks notice under the icy glare of my head nurse, knowing Id done the best I could to keep my patients safe. Notes on Nursing (1969 ed.). Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. Board of nursing rules outline the procedures nurses must follow to access these protections. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. The history of the American Nurses Association. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. 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. 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. 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. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). (2019). Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? (Dressner & Kissinger, 2018). Nurses who accept or make assignments must consider patient safety. 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. 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. You will receive email when new content is published. 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. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). (2016). What are the nurse's options here? Decide on what kind of signature to create. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. For example, a primary care physician and a specialist to whom the . 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. (2015). To err is human: Building a safer health system. 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. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. Of Montral those errors for engagement in policy by a Texas law who accept or make assignments consider! After their concerns were not addressed rate of comorbid conditions act in question invoke... Not qualified to care for the invocation of safe harbor before engaging the act in question any! 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