Online Journal of Issues in Nursing, 12(3). (2015). 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). Washington, DC: American Nurses Publishing. 5 pages, 2066 words 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. Nightingale, F. (1914). 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. 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. 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. 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). Minimum nurse-to-patient ratios in acute care hospitals in California. (Dressner & Kissinger, 2018). In 2019, legislation supported by NLAC as well as the Texas Hospital Association was proposed to establish Violence Prevention Committees within healthcare organizations (HB 2980); the effort failed (Zolnierek, 2019). 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). https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. Nurse staffing and patient, nurse, and financial outcomes. Are you unqualified to care for the patients assigned? I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. 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. History: . Nurse staffing, burnout, and health careassociated infection. A nurse must invoke safe harbor before engaging the act in question. Centers for Disease Control and Prevention (2013). Commenting is limited to medical professionals. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. What else can we do to ensure their care and their safety?. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. 25, No. State facts, include the date and time, and why you are refusing or objecting. Zolnierek, C. (2019). The Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). Texas Senate Bill No. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". 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. Kudzma, E. C. (2006). To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. (2007). Is the assignment outside the scope of your practice or your experience and knowledge level? 192, 2011). Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. 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. There are three variants; a typed, drawn or uploaded signature. (2003). (15) Safe Harbor--A process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good . Establishing a foundation for the role of nurses in evidence-based advocacy, she emphasized the progressive nature of nursing, urging: Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? (Nightingale, 1860, p. 40-41). 2410, 2019), which allows nurses to invoke safe harbor orally in situations where patient needs prevents nurses from leaving the beside to complete safe harbor forms. Safe patient handling U.S. enacted legislation snapshot. Montalvo, I. Neither the author or the website publisher are responsible for any actions a reader may take based on material in this article or on this website. Historical Information. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 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. Nurses who accept or make assignments must consider patient safety. A new law in New Mexico gives nurses another option. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. It is remarkable to reflect on the first nurse practice acts and consider that those empowered nurses advanced the profession more than a decade before women even had the right to vote. See Table for examples of these laws. Good luck! Ellen began her clinical practice in neuroscience nursing and for the past 20 years has focused on healthcare quality across the continuum of care from acute care hospitals, to community-based mental health, home care, and hospice. Safe Harbor for Nurses . Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). (2011). The NDNQI provided one of the first databases of patient and nurse outcome indicators and it is currently the only national database containing unit level data regarding nurse sensitive indicators. 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. How nurses advocated for their profession in the 86th legislative session. The federal level (CMS) requires certain staffing too. This website also contains material copyrighted by 3rd parties. Or go, try, risk making a mistake, and hope for the best? 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. 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. As for the two examples at the beginning, they happened and I was the nurse. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Cindy Zolnierek, PhD, RN, CAEEmail: [email protected]. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. 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. 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. For example, a primary care physician and a specialist to whom the . Nurses have an ethical imperative to engage in policy. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. 2410. Insurance companies pay the price for HAIs. Every nurse should be aware of the statutes and rules governing their profession. The shortage of qualified practicing nurses is not new. (BJ) Strickland is from Tennessee. 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. 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. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. 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. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. Then the nursing office pulls one of the two RNs on the rest of the unit, leaving two LPNs and a tech for the 18 beds. 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. 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. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. RN TO FNP TRANSITION | The First 6 Months. The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. My question is this. Simultaneously, they may be worried about their family and loved ones. Board of nursing rules outline the procedures nurses must follow to access these protections. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. Thank you for your comment. Orthopedic Nursing, 25(6), 366-379. (2000). She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. Effects of hospital care environment on patient mortality and nurse outcomes. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. Nursing peer review conducted by any entity must comply with NPR Law and with applicable Board rules related to incident-based or safe harbor nursing peer review. 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. 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. Why nurses need whistleblower protection. The American Nurses Association ([ANA], n.d., para. 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. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Texas was the first state to have safe patient handling and movement policies enacted in legislation. (2016). You tell the supervisor youve never worked oncology. 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. If the nurse files Safe Harbor and the reason is to prevent unsafe care for patients' then the nurse should theoretically be safe from retaliation, but if the nurse is only protecting themselves or their license then the BON will offer little protection from consequences at their facility. Texas Senate Bill No. Its a wrap! Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. Every nurse should be aware of the statutes and rules governing their profession. and keep a record of everything. Code of ethics with interpretive statements. 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. Our hospital is expected to staff this unit. 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). Notes on Nursing (1969 ed.). Nurse researchers play an important role in policy evaluation by studying the impact of policy changes.Such policies directly support nurse executives, often the decision-makers related to staffing, by offering a flexible approach to planning and budgeting nursing services. 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. 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. Like New Mexico's law, the Texas law allows a nurse to invoke safe harbor to question the medical reasonableness of a physician's order. (Read the story of how one nurse worked through TNA to make this possible.). In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. (2015). A few years later, nineteen nurses convened on February 22, 1907 to establish the Graduate Nurses Association of Texas, later renamed the Texas Nurses Association (TNA). To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. The completion of this project is a great example that through the dedication and generosity of all the partners who are working together, we are succeeding in finding concrete solutions to . Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. As gaps in protection are identified, nurses work to address them through policy change. 1, Manuscript 2. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. 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. 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. If you are a leader, do not punish the nurse objecting or refusing the assignment. Workplace violence. As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. 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. JOIN TNA AND ANA TODAY, 3/1/2023TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, 3/28/2023TPAPN Peer Support Partner Information Session, 3/31/2023Nuts & Bolts of Peer Review Workshop, 4/18/2023TPAPN Peer Support Partner Information Session, Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759, 800.862.2022 | 512.452.0645 | [email protected], Association Management Software Powered by, TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, TPAPN Peer Support Partner Information Session. Short title. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. The ANA position statement is an excellent resource to start. Protections are imperfect, but that does not diminish their importance. Texas was the first state to have safe patient handling and movement policies enacted in legislation. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. Share cases and questions with Physicians on Medscape Consult. I agree! Journal of Nursing Administration, 42(10), Supplement: S10S16. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 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. (2019). Any request for safe harbor, be it on this form or 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. 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? 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). 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. Kane. The statute was implemented in 2004. Nurses who accept or make assignments must consider patient safety. Texas Senate Bill No. Online Journal of Issues in Nursing, 9(3). 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