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? 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. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. (1999). Insurance companies pay the price for HAIs. This example represents a missed opportunity for nurses to change practice through policy. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. The Texas Nursing Practice Actincludes several advocacy protections for nurses.Although policy cannot completely prevent retaliation, the Patient Advocacy Protection Bill strengthened existing protections by increasing the penalties state licensing agencies can impose. 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. A nurse must invoke safe harbor before engaging the act in question. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. Cates, A. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. For example, the Texas State Board of Pharmacy (TSBP) . Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). I reference the ANA Code often with my students! New York, NY: Little, Brown Book Group. 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. (2007). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. The law also allows a nurse to invoke the safe harbor when he or she questions the medical reasonableness of another healthcare provider's order that the nurse is required to execute. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. 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. Share cases and questions with Physicians on Medscape Consult. 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. Our hospital is expected to staff this unit. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . Intended to improve the safety from physical injuries of both nurses and patients, SB 1525 was signed into law and took effect January 1, 2006. (2016). Zolnierek, C. (2019). Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. Any request for safe harbor, be it on this form or 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. Notify me of follow-up comments by email. I have worked NICU for 31 years. 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. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. See Table for examples of these laws. Medical Care, 45(12), 1195-1204. It is Christmas Eve and you report to your unit to work the night shift. 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). Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. NPAs have not remained stagnant over the past century, rather they have evolved but only with the active involvement of nurses in legislative efforts to change statute and update policies related to nursing practice. Texas Senate Bill No. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. (2011). Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. Kohn, L. T., Corrigan, J., & Donaldson, M. S. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. 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. However, we recognize that there are stories from every state that highlight the valuable work of many nurses that illustrate individual and collective nursing organization advocacy. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. One of the first objectives of the new organization was the passage of legislation in 1909 requiring registration of nurses through a Board of Nurse Examiners, creating the first nurse practice act in Texas (Brown, 2010). Nurse executives should support nurses who exercise their rights to protect their licenses and not view safe harbor requests as an affront to their leadership. Table. Solving tough problems through innovation and proven methodology. Nurse staffing, burnout, and health careassociated infection. 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. London: MacMillan and Company. 394, 1999). The nurse may supply supporting documents at a later time; however, the comprehensive details . Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. Code of ethics with interpretive statements. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. 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. The Safe Harbor Rule (SHPR) is a nursing peer review process that any type of nurse (licensed vocational nurse or registered nurse) can initiate in good faith whenever asked to take part in assignments or conduct that might result in one or more violations of Texas Board of Nursing rules and statutes. If you have legal questions, please speak with a licensed attorney in your area. No nurse, from a patient safety and legal liability standpoint, should ever be assigned primary care responsibility for patients that they are unqualified to care for yes, your license says you MAY care for these patients BUT that is only AFTER youve had training and supervision. Licensure eligibility criteria and the first licensure exam were developed in 1904. Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. Safe patient handling and mobility. The Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). Refuse the assignment, and face disciplinary action? Decide on what kind of signature to create. Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. You fill out a form that basically says that your work environment is unsafe and you will continue to care for your patients to the best of your ability, but are not held responsible for mistakes that are made. What do you do? And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. 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, . As for the two examples at the beginning, they happened and I was the nurse. (BJ) Strickland is from Tennessee. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Silver Springs, MD: American Nurses Association. Safe patient handling U.S. enacted legislation snapshot. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). 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. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 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. I had the next two days off; I interviewed at another hospital where I was immediately hired. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. 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? Responding to a disaster is a familiar process for several nurses in Texas. 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). 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 . 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! What else can we do to ensure their care and their safety?. 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. Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. North Carolina enacted the first nurse registration law in 1903. Texas Nursing Voice, 5(3):1, 4. 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 is resource intensive and is the largest component of hospital operational budgets.The complexity of nursing characteristics (e.g., skill mix); patient characteristics (e.g., acuity and case mix); and the interaction of these variables within the hospital environment make it extremely difficult to define a template as simple as a nurse-to-patient ratio to ensure appropriate staffing (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007; Unruh, 2008). I appreciate the legal advice. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. This law requires hospitals and nursing homes to adopt policies and procedures for the safe handling of patients that control the risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. (Texas Senate Bill 1525, 2005). History: . 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. American Nurses Association. (2003). Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. Citation: Martin, E., Zolnierek, C., (January 31, 2020) "Beyond the Nurse Practice Act: Making a Difference through Advocacy" OJIN: The Online Journal of Issues in Nursing Vol. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). Input from nurses is the foundation of this advocacy work to identify the need for policy change and make the case for why change is needed. The facility may not retaliate against the nurse who invokes the safe harbor. Small, H. (2017). Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. This is retaliation and it is barred by law and professional practice rules. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Effects of hospital care environment on patient mortality and nurse outcomes. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. Nurse staffing and patient, nurse, and financial outcomes. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Imagine this scenario: A nurse who has worked for 2 years in an adult medical-surgical unit reports for work and learns that she is assigned to work in neonatal intensive care that day. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. Nurse practice acts guide and govern nursing practice. The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. 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. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). 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. Washington, DC: National Academy Press. 6, ANA, 2009). 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. I got some help. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. (2015). Time now is 10:30 and you just begin your med pass. 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. Every nurse should be aware of the statutes and rules governing their profession. Put your objections or refusal in writing. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). New Mexico's law was inspired by a Texas law. Often policy change involves an incremental approach that requires persistence. We conclude by considering the common thread among these exemplars. 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. 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). Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. 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. Dont use subjective or accusatory terms such as short-staffing. Sign it. 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. Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . doi: 10.1097/01.NNA.0000312773.42352.d7, American Nurses Association. The statute was implemented in 2004. The unit also has 18 general medical beds. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. What do you do? (2007). Taylor, J. L. (2010). 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. 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). 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations.Hospitals were compelled to focus specifically on safety when in 1999 the Institute of Medicine (IOM) released its groundbreaking report, To Err is Human (Kohn, Corrigan, & Donaldson, 2000). Nurses are warm, compassionate and forgiving to a fault. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. As gaps in protection are identified, nurses work to address them through policy change. Workplace violence study. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. Its a wrap! 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. 25, No. Often policy change involves an incremental approach that requires persistence. and keep a record of everything. Nurse(s) Name(s) invoking Safe Harbor: 2. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. (2009). We conclude by considering implications for nursing organizations and nurses among these exemplars. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). And use the experience to identify potential staff or policy needs and ways to respond future... 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safe harbor nursing examples