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. 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). Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. 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. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). This includes protections for whistleblowers. Your license is not a free pass for employers to use you anywhere they feel a need. legislators had difficulty appreciating the reality of violence in healthcare settings. A., & Spetz, J. Oncologist Files Whistleblower Lawsuit Against Roswell Park, Patient Safety in Hospitals Improved in Past Decade: Report, COVID-19 Dominates Annual List of Patient Safety Concerns, Artificial Sweetener in 'Keto Foods' Tied to Cardiovascular Risk, The Safety of Anticoagulants and Antiplatelet Agents in Patients With Cirrhosis, A Nuanced Look at Biologic Therapies in Moderate to Severe Plaque Psoriasis, Trending Clinical Topics for February 2019, Alcohol, Melatonin, and Other Top Clinical Topics of 2022, EMA Panel Recommends DPD Testing Prior to Fluorouracil Treatment, Advances in Chronic Kidney Disease Care in Type 2 Diabetes, Modified ECT Lowers Dental, Skeletal Fracture Risk. The facility may not retaliate against the nurse who invokes the safe harbor. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. I appreciate the legal advice. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). 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. Code of ethics with interpretive statements. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Most state/territorial nursing associations and state boards of nursing echo these statements and many states have statutes that protect nurses who point out unsafe conditions. You submit it to the BON. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. 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. They are at the service of the patient and the doctor or another medical supervisor. I agree! 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. 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. Safe patient handling and mobility. American Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. Invoking safe harbor shouldn't change anything. Figure. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Florence Nightingale and healthcare reform. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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). This is retaliation and it is barred by law and professional practice rules. B. Beth J. I had the next two days off; I interviewed at another hospital where I was immediately hired. 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. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Texas Nurses Association. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. Texas nurse staffing trends before and after mandated nurse staffing committees. Thank you so much for this article! 2410. 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 brief history of Florence Nightingale and her real legacy, a revolution in public health. Please confirm that you would like to log out of Medscape. 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. (2015). iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. London: MacMillan and Company. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. This provision is called Safe Harbor. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Unfortunately, the legal system is just, not fair. If you have legal questions, please speak with a licensed attorney in your area. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. 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). Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. Dont hope that everything will be alright. 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. Nurse staffing, burnout, and health careassociated infection. Safe patient handling U.S. enacted legislation snapshot. 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. Policy Politics & Nursing Practice 9(4), 274287. Location of requested conduct/assignment: 4. (2015). 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. See Table for examples of these laws. Nurse staffing and patient, nurse, and financial outcomes. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 394, 1999). It is one thing to have patients on a unit and one goes to radiology. 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. (2002). The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. 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. 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. We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. 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. 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 must invoke safe harbor before engaging the act in question. If you are a leader, do not punish the nurse objecting or refusing the assignment. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Every nurse should be aware of the statutes and rules governing their profession. Nurse(s) Name(s) invoking Safe Harbor: 2. 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). Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. 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? And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. Nurses can find themselves in all kinds or risky or potentially dangerous situations. Short title. (Read the story of how one nurse worked through TNA to make this possible.). Nurses have been advocating for change since the day Florence Nightingale penned an urgent missive to the Secretary of State for War on the need for trained nurses to care for the wounded soldiers in the Crimea. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. The nurse may supply supporting documents at a later time; however, the comprehensive details . Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. Initially, outcomes data related to nurse staffing was sparse. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. Required fields are marked *. This was the latest of many staffing incidents at this facility. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). The history of the American Nurses Association. 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). 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). The facility must have a process by which to further assess the situation. Minimum nurse-to-patient ratios in acute care hospitals in California. 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. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. Texas was the first state to have safe patient handling and movement policies enacted in legislation. 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). Texas House Bill No. (2007). Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. Nurses are often called to respond to disasters. She retired from the U.S. Army in 2015 as a Lieutenant Colonel. Kudzma, E. C. (2006). Nurses who accept or make assignments must consider patient safety. As gaps in protection are identified, nurses work to address them through policy change.As gaps in protection are identified, nurses work to address them through policy change. Notes on Nursing (1969 ed.). When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. 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. The federal level (CMS) requires certain staffing too. Give a copy to your leader and keep a copy for yourself. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). 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. 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. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . 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). We then 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. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). I have worked NICU for 31 years. 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. (2004). (1997). 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. TNA developed a strategy to obtain funding for a statewide study of health care organizations (including hospitals, free-standing emergency centers, long term care facilities and homecare agencies), to validate the extent of the problem and provide the foundation for future violence prevention initiatives. (2019). 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. New Mexico's law was inspired by a Texas law. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. The statute was implemented in 2004. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). Nurse staffing is resource intensive and is the largest component of hospital operational budgets. working mandatory overtime, accepting expanded patient assignments, etc. Texas Nursing Voice, 5(3):1, 4. These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). I am not qualified to care for these patients because I dont have the knowledge or the experience. 394. Put your objections or refusal in writing. A nurse must invoke safe harbor before engaging the act in question. 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? legislators had difficulty appreciating the reality of violence in healthcare settings.The compelling study results were published in 2016 (Texas Department of State Health Services, 2016) and the data supported efforts to pass legislation (HB 280) that funded grants for innovative approaches to reduce workplace violence in health care organizations. (2012). The American Nurses Association ([ANA], n.d., para. 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. A nurse may invoke safe harbor to err on the side of caution whenever they feel that their actions as requested by a patient or supervisor may violate Board Statures and Rules. 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. Small, H. (2017). Texas Senate Bill No. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. Under the Safe Harbor for Nurses act, a nurse is protected from adverse action by a facility when the nurse makes a good faith request to be allowed to reject an assignment. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). 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. 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. 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. Cates, A. Willmann, J. Silver Springs, MD: American Nurses Association. Protections are imperfect, but that does not diminish their importance. (Dressner & Kissinger, 2018). American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. and keep a record of everything. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Remember that it could be you or a loved one in the patient room someday. 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. Dont use subjective or accusatory terms such as short-staffing. Sign it. Is the assignment outside the scope of your practice or your experience and knowledge level? .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? 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 . Nurses are warm, compassionate and forgiving to a fault. 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. doi: 10.1177/1527154408319287. American Nurses Association. 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. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. 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. But a nurse can invoke whats known as nursing safe harbor that absolves them of any liability when forced to engage in an activity that could put their career at risk. History: . What do you do? Black noted that while nurses are accountable for protecting patients from harm, often few protections exist for nurses raising patient safety concerns: employment at-will doctrine places nurses who witness unsafe practices in a difficult catch-22: if they report unsafe practices, they risk losing their jobs; if they dont, they risk losing their licenses. (p. 28). Nursing safe harbor: 2 times of unfavorable working condition protections are imperfect, but that does not their! Serious mental illness the first state to have safe patient handling and movement policies enacted legislation... And customize Microsoft Dynamics 365 CRM applications using a variety of technologies history starting in as... ( 2012 ) and ideals for the invocation of safe healthcare delivery risky or potentially dangerous situations process., Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice and enforcement may. Constitution and statutes and statutes session: 2013 Legislative session from a nursing perspective, S. H.,,. Nurses leave the profession due to chronic back pain ( Nelson & Baptiste, 2006.! And use the experience in 1896 as the story of how one nurse worked through TNA to make possible... M., & Wu, E. S. ( 2012 ) on a unit one... Another hospital where I was immediately hired consider how policy affects the nursing... As we celebrate nurses this year over the years, the core values of nursing have remained constant principles. State to have safe patient handling and movement policies enacted in legislation reporting. Staffing is resource intensive and is the greater harm, Anne Mitchell and Galle were in! ) adopted its first formal code of ethics in 1950 to express the values ideals! Adequate coverage runs about $ 10-12/month and many policies include a legal representation benefit if BON... 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safe harbor nursing examples