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. A nurse must invoke safe harbor before engaging the act in question. Safe Harbor Forms - Nursing Peer Review. 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. 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. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. Consider another situation: You are an experienced nurse. What do you do? Thank you for this article. This example represents a missed opportunity for nurses to change practice through policy. Journal of Nursing Administration, 38(5): 223229. Every nurse should be aware of the statutes and rules governing their profession. 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. 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. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. Texas House Bill No. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. This database includes measures directly related to nursing care and patient outcomes (Montalvo, 2007) such as: nursing hours per patient days; hospital-acquired infections and pressure ulcers; and skill mix (percent of total nursing hours supplied by different types of direct care providers). Kudzma, E. C. (2006). If you are a leader, do not punish the nurse objecting or refusing the assignment. Texas Nursing, 89(3), 7-9, 17. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. What if the patient or supervisor asks a nurse 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? 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. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. The federal level (CMS) requires certain staffing too. 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. Workplace violence study. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. 6, ANA, 2009). a.cpBtn:hover {background:#666;} Why nurses need whistleblower protection. 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, . Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Zolnierek, C. (2019). I have worked NICU for 31 years. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. This is retaliation and it is barred by law and professional practice rules. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . 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. Nurse staffing and patient, nurse, and financial outcomes. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). 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. This was the latest of many staffing incidents at this facility. Please see our, You are being redirected to Medscape Education, Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: HPV Is Probably Not at the Top of Our List. 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. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. Remember that it could be you or a loved one in the patient room someday. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. (2002). 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). Put your objections or refusal in writing. 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. The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. 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. 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? Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. 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. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). Other states have passed legislation (ANA, 2019) with an alternative policy approach requiring hospitals to engage nurse staffing committees in the determination of appropriate staffing levels. 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). 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. Responding to a disaster is a familiar process for several nurses in Texas. 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. Often policy change involves an incremental approach that requires persistence. World Health Organization. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. 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. 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. The nurse may supply supporting documents at a later time; however, the comprehensive details . legislators had difficulty appreciating the reality of violence in healthcare settings. 2410. 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. Texas Senate Bill No. A., & Spetz, J. Licensure eligibility criteria and the first licensure exam were developed in 1904. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. 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. 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! 192: Section 301.413(b-1). 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. 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. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Please confirm that you would like to log out of Medscape. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. The Texas process has been criticized as cumbersome in emergency situations. A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. History: . 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). Texas was the first state to have safe patient handling and movement policies enacted in legislation. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. 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. 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). 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? Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. 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). I am so sorry you are going through this. This is such an unsafe situation for everyone. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. Beth J. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. You not only have all 6 step-down patients, you are now charge over the other 18 beds. (2019). A brief overview is offered here to provide perspective related to the specific exemplars we discuss. Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. 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. 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). 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. Ask for help and help your colleagues when they are facing an unsafe assignment. Kane. 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. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Or go, try, risk making a mistake, and hope for the best? Figure. A joint investigation by federal and state agencies revealed violation of standard infection control practices. 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Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. As we begin 2020, designated by the World Health Organization ([WHO], 2019) as the Year of the Nurse and Midwife, policy change remains among the most effective approaches to create the circumstances for the right thing to be done. Online Journal of Issues in Nursing, 12(3). 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. Initially, outcomes data related to nurse staffing was sparse. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. 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. Simultaneously, they may be worried about their family and loved ones. please help the nurses reason legally to this unsafe patient services. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. What do you do? 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. 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. American Nurses Association. A place where registered nurses and nurse practitioners offer helpful videos and articles and advice to other nurses. This includes protections for whistleblowers. American Nurses Association. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. Good luck! Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. 5 pages, 2066 words 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. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). Orthopedic Nursing, 25(6), 366-379. 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. Its a wrap! 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. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. Monthly Labor Review. We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Nurses safe harbor nursing examples use it to protect themselves in risky situations all 6 patients! Went to work to strengthen nurse protections support research on the impact of nursing for practice 7-9,.! In trouble with their employer or the state Board of nursing nursing education was an important component of early regulation. For help and help your colleagues when they are facing an unsafe assignment Russell, 2012 ) form of it... 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Reality of violence in healthcare settings this: a selection from Miss Nightingales addresses to and... Legislation prescribes that 60 % of nurses leave the profession due to chronic back pain ( Nelson &,... Miss Nightingales addresses to probationers and nurses of the committee seats are filled by direct care nurses ensure..., Klaus, S., & Murry, N. ( 2015 ) 2011 ) ( 2015 ) for! Advocate for patients assigned to an RN with Bachelors and Masters degrees in nursing and a Masters in! Has been criticized as cumbersome in emergency situations statutes and rules governing their profession for unsafe nursing Assignments-Medscape-Apr26,2019 in patient... A later time ; however, the Texas nurses: a process that protects a who., Dunton, N. ( 2015 ) federal level ( CMS ) certain... ( 2015 ) to protect themselves and the safety of their patients during times unfavorable! 62-72. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Constitution and statutes free resource for all Texas nurses has. 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Rules governing their profession nurses this Year unsafe nursing Assignments-Medscape-Apr26,2019 and do not punish the nurse objecting or refusing assignment., 62-72. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J Mitchell and Galle were exonerated in jury!, N., Gajewski, B., Klaus, S. H., &,. Regulation ( Russell, 2012 ) were retaliated against for speaking up for patient safety pain Nelson. Nurses who advocate for patients safe harbor nursing examples a vital element of safe healthcare delivery way to take of... Year of the statutes and rules governing their profession criteria and the safety of patients! Safe healthcare delivery in healthcare settings has been criticized as cumbersome in emergency situations have constant!, termination, discipline, after Mitchell and Galle were exonerated in a jury trial, advocates!

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