394, 1999). Date/Time of Request: 3. 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. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. 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. The Texas Nursing Practice Actincludes several advocacy protections for nurses. Texas Nursing, 89(3), 7-9, 17. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. 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. 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. of nursing care for a defined work period in a defined work setting, including the specified functions, duties, practitioner orders, supervisory directives and amount of . doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). The unit also has 18 general medical beds. for Nursing Education. 1, Manuscript 2. You've successfully added to your alerts. This is retaliation and it is barred by law and professional practice rules. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. 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. 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. (2019, January 30). Legislative update: TNA protects nurses in 84th session. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. 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. They are at the service of the patient and the doctor or another medical supervisor. All rights reserved. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. This accountability came in the form of changes in payment policy. 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. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Recently our hospital has opened an adult unit as an overflow from the University hospital. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. Texas Nurses Association. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. 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). Washington, DC: National Academy Press. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. 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. Refuse the assignment, and face disciplinary action? A., & Spetz, J. 2022 American Nurses Association. Medical Care, 45(12), 1195-1204. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Texas Nursing Voice, 5(3):1, 4. If you have legal questions, please speak with a licensed attorney in your area. or local laws, rules or regulations affecting the nurse's current area of nursing practice. 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. 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. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy most policy work involves collaboration among nurses and other stakeholders. 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? 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. Nelson, A., & Baptiste, A. S. (2006). As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. Orthopedic Nursing, 25(6), 366-379. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. Texas nurse staffing trends before and after mandated nurse staffing committees. 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. Policy Politics & Nursing Practice 9(4), 274287. Monthly Labor Review. American Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. I agree! (North Carolina Board of Nursing, 2019). 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: Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. 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. 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. How has Covid amplified issues to your culture? 16, New York companion bills A11484, A07836, S05116, and S08358. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). (2011). The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. Both professional nursing organizations, and individual nurses, must continue advocacy at all levels. Nurse staffing, burnout, and health careassociated infection. Nurse staffing and patient, nurse, and financial outcomes. Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. 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. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. I reference the ANA Code often with my students! Im in the first stages of getting into nursing school and this article basically sums up my concerns and addresses them exactly! Safe Harbor for Nurses . 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. 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. 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. Safe Harbor Forms - Nursing Peer Review. Your email address will not be published. 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. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Nightingale, F. (1860). 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. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. Please enter a Recipient Address and/or check the Send me a copy checkbox. Nightingale, F. (1914). (2016). In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. 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. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 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. This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. This article is not legal advice. 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. Short title. 61-3A-1. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. 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. 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. (2003). Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. 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, . The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. doi: 10.1097/01.NNA.0000312773.42352.d7, American Nurses Association. It is not enough to say that we want what is best for our patients; we must also do what is best for our patients. Texas was the first state to have safe patient handling and movement policies enacted in legislation. The federal level (CMS) requires certain staffing too. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. North Carolina enacted the first nurse registration law in 1903. We 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 in our state. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. You will receive email when new content is published. New Mexico's law was inspired by a Texas law. A new law in New Mexico gives nurses another option. RN TO FNP TRANSITION | The First 6 Months. My apologies for not answering sooner. Every nurse should be aware of the statutes and rules governing their profession. Safe patient handling and mobility. (2019). This example represents a missed opportunity for nurses to change practice through policy. (2013). This is such an unsafe situation for everyone. (Dressner & Kissinger, 2018). 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