With the increasing availability of information about preventable errors and complications of hospital care, particularly those related to nursing care, hospitals were called to higher levels of accountability for patient outcomes. A medical director or member of the medical staff must determine whether the order was reasonable. 2011 Session: A roller coaster ride for nursing. 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! We conclude by considering implications for nursing organizations and nurses among these exemplars. Texas Senate Bill No. (2004). 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. 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. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? If you are a leader, do not punish the nurse objecting or refusing the assignment. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. 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. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. (2019). An existing policy of enhanced criminal penalties for assaults against first responders, such as peace officers, firefighters, and emergency medical service workers (which elevated the seriousness of the offense from a misdemeanor to a felony) inspired a similar approach to deter violence against nurses. 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. (2013). Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. (2002). The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. Dont hope that everything will be alright. This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. (2007). All rights reserved. Successful advocacy requires the identification of concerns by individual nurses, coupled with leadership and persistence of nursing organizations with strength in numbers and a policy agenda. Texas Senate Bill No. Refuse the assignment, and face disciplinary action? To err is human: Building a safer health system. 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. There are three variants; a typed, drawn or uploaded signature. 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). 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). American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. The Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). Notify me of follow-up comments by email. 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. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. 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: 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. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Texas Board of Nursing (TBON, n.d.a) clarifies Safe Harbor as a nursing peer review process the nurse may initiate, under good faith, when asked to engage in assignments or conduct the nurse believes to violate Standards of Practice, Duty to Patient, or . Often policy change involves an incremental approach that requires persistence. Good luck! My apologies for not answering sooner. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. 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. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). Nurses dont always have a lot of authority on the floor, so they need to learn how to protect themselves if someone asks them to do something that goes against their ethics or the law. and keep a record of everything. 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 act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". American Nurses Association. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. Cates, A. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). 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. Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. 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). Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. 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. 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). 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 researchers play an important role in policy evaluation by studying the impact of policy changes. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. 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. American Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. A nurse must invoke safe harbor before engaging the act in question. As gaps in protection are identified, nurses work to address them through policy change. 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. 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. 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? 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. The Texas process has been criticized as cumbersome in emergency situations. Willmann, J. We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. 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. The nurse may supply supporting documents at a later time; however, the comprehensive details . Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. 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. 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). This is retaliation and it is barred by law and professional practice rules. 394. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). 1, Manuscript 2. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. Thank you! Good luck! They are at the service of the patient and the doctor or another medical supervisor. Recently our hospital has opened an adult unit as an overflow from the University hospital. A., & Spetz, J. (2009). Nurse practice acts guide and govern nursing practice. 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. 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. 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). 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. For example, the Texas State Board of Pharmacy (TSBP) . Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. please help the nurses reason legally to this unsafe patient services. You tell the supervisor youve never worked oncology. Minimum nurse-to-patient ratios in acute care hospitals in California. As gaps in protection are identified, nurses work to address them through policy change. Protection failures represent opportunities for future advocacy. Silver Springs, MD: American Nurses Association. The Texas law applies to employers of eight or more nurses. This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. See Table for examples of these laws. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). 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. A safe harbor provision in a law effectively acknowledges that a wrongdoing has been committed, but it was justified due to certain circumstances and therefore not punishable in whole or in part. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. 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. I work at a Childrens and Womens hospital. (2007). Short title. Texas took a slightly different approach to the problem. How nurses advocated for their profession in the 86th legislative session. Nurses who accept or make assignments must consider patient safety. Your email address will not be published. Small, H. (2017). working mandatory overtime, accepting expanded patient assignments, etc. Kane. Legislative update: TNA protects nurses in 84th session. 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. After the hard work is finished and the policy becomes how we practice, the origin stories are lost, and progress is often taken for granted. Initially, outcomes data related to nurse staffing was sparse. (2003). 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. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. North Carolina enacted the first nurse registration law in 1903. 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. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Give a copy to your leader and keep a copy for yourself. The history of the American Nurses Association. 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. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. 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. 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. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. 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. For example, a telemetry unit in one small community hospital can compare its pressure ulcer and vacancy rates to a similar unit in another community hospital. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. Time now is 10:30 and you just begin your med pass. Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). It is offered only as information about nursing topics of interest. A joint investigation by federal and state agencies revealed violation of standard infection control practices. 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? These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). 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). In Handbook of Texas Online. It is Christmas Eve and you report to your unit to work the night shift. It is one thing to have patients on a unit and one goes to radiology. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Nurses are warm, compassionate and forgiving to a fault. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. A new law in New Mexico gives nurses another option. (2015). 1525. (North Carolina Board of Nursing, 2019). I had the next two days off; I interviewed at another hospital where I was immediately hired. (2011). A brief overview is offered here to provide perspective related to the specific exemplars we discuss. The federal level (CMS) requires certain staffing too. Consider another situation: You are an experienced nurse. 6, ANA, 2009). Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. New York, NY: Dover Publications. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. Given the outcome and scope of the outcomes of successful advocacy, and the failure to advocate discussed above, it is important to address the need for advocacy protections. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. You not only have all 6 step-down patients, you are now charge over the other 18 beds. Kudzma, E. C. (2006). Revision of the code in 1995 expanded it to include social ethics, global concerns, and emphasis on the important role of nurses in health policy. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . (2012). In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. You will receive email when new content is published. (2016). Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. 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. (2019). In this case, all they need to do is write down the information listed above and hand it to a superior, letting them know that safe harbor is being requested. Although both bills failed to pass in 2011 (Willmann, 2011), similar legislation enhancing penalties for assault of emergency department personnel passed in the next legislative session (Willmann, 2013). Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. 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. I agree! Centers for Disease Control and Prevention (2013). The Texas Nursing Practice Actincludes several advocacy protections for nurses. For example, a primary care physician and a specialist to whom the . The relationship of nursing workforce characteristics to patient outcomes. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Safe patient handling U.S. enacted legislation snapshot. Decide on what kind of signature to create. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. (2007). Advocacy in Nursing Regulation: Nurse Practice ActsThe original intent of nurse practice acts was the regulation of nursing practice through registration, now licensure (Russell, 2012). 3-4 ), 61-64. doi: 10.1177/0894318405283556 of nurses ' attitudes toward patient advocacy and Whistleblower,. Minimum nurse-to-patient ratios in acute care hospitals in California to err is human Building! Session: 2013 legislative session, 115 patients at risk for harm PhD, RN CPHQ. To your unit to work the night shift, etc to Improve safe Handling, Hawaii House Concurrent No. The supervisor told me to do the best I could, and can not this. Best I could, and can not accept this assignment because my of... Copy for yourself in the disaster work environment criminally indicted for a third-degree felony ( Thomas & Willman 2012. None of my patients died that night nurses Association. ), Texas Department of State Legislation to Improve Handling... Data related to the problem in Texas as well postoccurrence review of the nurse and supervisor document the,... At two endoscopy clinics were infected with the hepatitis C virus organizations and nurses among these.... Has opened an adult unit as an overflow from the University hospital smoking in the legislative... 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