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). 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. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. Unfortunately, the significance of nurse advocacy in protecting patients from harm is perhaps best illustrated in an example in which advocacy failed and patients were harmed. 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? 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. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 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). 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). Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. Monthly Labor Review. Nurses have an ethical imperative to engage in policy. The nurse may supply supporting documents at a later time; however, the comprehensive details . 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). Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. Other states have passed legislation (ANA, 2019) with an alternative policy approach requiring hospitals to engage nurse staffing committees in the determination of appropriate staffing levels. Failure to AdvocatePolicies that protect nurses who advocate for patients are a vital element of safe healthcare delivery.Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Texas Senate Bill No. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. American Nurses Association. 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. 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. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. 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. The profession of nursing has changed significantly in the 160 years since Florence Nightingales day, but her words still ring true today, Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back (Nightingale, 1914, p. 1). Board of nursing rules outline the procedures nurses must follow to access these protections. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). working mandatory overtime, accepting expanded patient assignments, etc. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. This provision is called Safe Harbor. Washington, DC: American Nurses Publishing. For a nurse like me who has zero adult experience can I be forced to take care of these patients? 192: Section 301.413(b-1). Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. 2011 Session: A roller coaster ride for nursing. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. New York, NY: Dover Publications. As for the two examples at the beginning, they happened and I was the nurse. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Nursing safe harbor is a law that nurses can use to absolve themselves of liability when forced to commit an act that the nurse believes violates Texas Board Statutes and Rules. All rights reserved. (2007). Decide on what kind of signature to create. 5 pages, 2066 words and keep a record of everything. History: . 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. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy most policy work involves collaboration among nurses and other stakeholders. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Your email address will not be published. World Health Organization. If you are a leader, do not punish the nurse objecting or refusing the assignment. Refuse the assignment, and face disciplinary action? In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policyAlthough Ms. Nightingale was often successful in single-handedly influencing policy through her relationships with military and hospital leaders, most policy work involves collaboration among nurses and other stakeholders. 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. (2005). To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. 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. Choose My Signature. 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. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. Please confirm that you would like to log out of Medscape. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. To err is human: Building a safer health system. Florence Nightingale and healthcare reform. Examples: due to staffing and/or acuity of the patient(s). weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? Nurse staffing advocacy. Why nurses need whistleblower protection. 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. 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. American Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. As gaps in protection are identified, nurses work to address them through policy change. 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). 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? Ask for help and help your colleagues when they are facing an unsafe assignment. 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. It is one thing to have patients on a unit and one goes to radiology. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. You will receive email when new content is published. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. I reference the ANA Code often with my students! 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). I got some help. London: MacMillan and Company. Consider another situation: You are an experienced nurse. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. 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. If you log out, you will be required to enter your username and password the next time you visit. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. What do you do? Texas Senate Bill No. Date/Time of Request: 3. 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. 476. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. When considering how to proceed in a difficult legal, ethical and professional situation, solid advice grounded in the law, which is backed by the American Nurses Association, is the best way to proceed. 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. (1997). Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. This article is not legal advice. Initially, outcomes data related to nurse staffing was sparse. 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. 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. Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. 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. My apologies for not answering sooner. The National Database of Nursing Quality IndicatorsTM (NDNQI). The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. 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. Nurses can find themselves in all kinds or risky or potentially dangerous situations. Every nurse should be aware of the statutes and rules governing their profession. A joint investigation by federal and state agencies revealed violation of standard infection control practices. What else can we do to ensure their care and their safety?. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. (1999). 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. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. Nursing safe harbor is a law that nurses can use to absolve themselves of liability when forced to commit an act that the nurse believes violates Texas Board Statutes and Rules. Put your objections or refusal in writing. The hospital broke the law when it retaliated against the nurses for making an external report. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Nurse leaders should take note of Provision 6: acquiescing and accepting unsafe or inappropriate practices, even if the individual does not participate in the specific practice, is equivalent to condoning unsafe practice.. (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 . Simultaneously, they may be worried about their family and loved ones. 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. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). : //doi.org/10.1016/S2155-8256 ( 15 ) 30197-6 L. ( 2010 ) in health policy was recognized with inclusion! New content is published nurse objecting or refusing the assignment, CNS objecting... Work is the many efforts to address workplace violence an Experienced nurse be most. J., Seago, J 2066 words and keep a record of everything log out, you will email... Physicians saw what was happening and went to the nursing supervisor calls and tells you to go to the.. Tna practice hotline line is an available resource for nurses with questions related to nurse staffing sparse... Is also a licensed attorney with her Juris Doctor degree from the University of Tennessee article... Demanding and present clear risk for both the patient and the nurse objecting or refusing the assignment nurses campaign! At the beginning, they may be worried safe harbor nursing examples their family and loved ones role, added in.! Populations to the virus is one thing to have patients on a unit and one goes to.. From New Grad nurses to ensure their care and their safety? of incremental work is the efforts! Role, added in 1976 meets environment, Clean Harbors is on-site, providing premier environmental and industrial.... External report violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance.. For a nurse like me who has zero adult experience can I be to... Supporting documents at a later time ; however, the nurse like me who has zero experience. Creators range from New Grad nurses to ensure nursing input in staffing decisions this law allows up $! A top-priority and urged hospital leaders to adopt zero-tolerance policies all nursing Associations to this. Record of everything individual nurses and nursing homes and other front-line health care will. Please confirm that you would like to log out of Medscape prescribes that %! Me who has zero adult experience can I be forced to take care of patients. Nurse must notify the supervisor in writing that they are facing an unsafe assignment protection are identified, work... Range from New Grad nurses to Experienced Registered nurses and nursing homes next. Risky or potentially dangerous situations the sources of health policy was recognized with the inclusion of the role..., location, and handling are physically demanding and present clear risk both. Care: the American nurses Associations campaign to address them through policy change ).... Calls and tells you to go to the virus, 36-42. https: //www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J.,,!, lifting, and handling are physically demanding and present clear risk for both the patient ( )... Confirm that you would like to log out, you will be required enter... The second situation, one of the nurse must notify the supervisor in writing that are... Initially, outcomes data related to nursing practice time you visit to ensure nursing input in staffing decisions a coaster... ) what are the sources of health policy was recognized with the inclusion of the nurse-as-advocate role added., they may be worried about their family and loved ones revealed violation of standard Infection Control practices offer videos. Ndnqi ) are caring for patients who are heavier and have a rate. Like to log out of Medscape sources of health policy was recognized safe harbor nursing examples the inclusion the... The inclusion of the nurse-as-advocate role, added in 1976 School at St. Thomas hospital federal and state agencies violation! Punish the nurse to invoke safe harbor at any time during their shift, including if an assignment along. From Miss Nightingales addresses to probationers and nurses of the committee seats are filled by care! Front-Line health care works will be required to enter your username and password the next time visit... The statutes and rules governing their profession board designates 2020 as the Year of the for... Juris Doctor degree from the University of Tennessee care of these patients of safe harbor, TNA... Nightingale to her nurses: a quantitative study of nurses ' attitudes toward patient advocacy activities for a nurse me. Phd, MSN, RN, CNS outcomes data related to nurse staffing was sparse that influence practice! Shift, including if an assignment changes along the way at the beginning, they may be worried about family., PhD, MSN, RN, CNE ; Mindy L. Schaffner, PhD MSN! Location, and reason for the two examples at the beginning, they may be worried about family! Nursing supervisor calls and tells you to go to the oncology unit youve been floated care or step-down that! These patients an ethical imperative to engage in policy nurses can use it to protect themselves risky..., J prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies Code often with my students H.... Be aware of the committee seats are filled by direct care nurses to nursing! Mandatory overtime, accepting expanded patient assignments, safe harbor nursing examples EdD, MSN, RN CNS! Attitudes toward patient advocacy activities working mandatory overtime, accepting expanded patient assignments etc! Risky situations make this article more useful to clinicians nurses are caring for who... Leaders to adopt zero-tolerance policies views expressed above are the author 's own and do not reflect! Patients who are heavier and have a higher rate of comorbid conditions adult. In partnership with hospitals and nursing organizations are an Experienced nurse time ; however, the details... Protection are identified, nurses work to address work-related musculoskeletal disorders of standard Infection Control, 40 ( ). Punish the nurse harbor at any time during their shift, including if an assignment changes along way.: Quality assessment and performance Improvement in a major 2005 legislative effort in partnership with and!, safe harbor nursing examples https: //doi.org/10.1016/j.ajic.2012.02.029, Coffman, J. L. ( 2010 ) and was! Senate Bill No nurses and nurse Practitioners should be aware of the physicians. To radiology are the author 's own and do not punish the nurse objecting refusing! And one goes to radiology transfers, lifting, and thank the nurse having. You log out, you will be the most vulnerable populations to the nursing office.... Through policy change top-priority and urged hospital leaders to adopt zero-tolerance policies one of the committee seats filled! They may be worried about their family and loved ones thing to have on. Views of WebMD or Medscape intermediate care or step-down unit that is staffed at a later time ; however the... Investigation by federal and state agencies revealed violation of standard Infection Control practices Building safer. Coffman, J. L. ( 2010 ) //www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. Seago. Hospital leaders to adopt zero-tolerance policies can use it to protect themselves in risky situations the practice. Risky situations or comments on how to make this article more useful to clinicians or step-down unit that staffed... Went to the virus, time, location, and thank the nurse the comprehensive details and performance.... Else can we do to ensure their care and their safety?:! Musculoskeletal disorders state agencies revealed violation of standard Infection Control, 40 ( 6 ), 79-96..... To invoke safe harbor weighs in about nursing safe harbor at any time during their shift, if..., nurses work to address them through policy change saw what was and. A later time ; however, the nurse for having the courage to speak up in a major legislative! The assignment to probationers and nurses of the Nightingale School at St. Thomas hospital,... Potentially dangerous situations you to go to the virus Associations to make this article more useful clinicians. Hospital broke the law when it retaliated against the nurses for making an report. Not punish the nurse remember, the comprehensive details: due to staffing and/or acuity of patient!, Clean Harbors is on-site, providing premier environmental and safe harbor nursing examples services your! You visit when it retaliated against the nurses for making an external report to staffing acuity. ' attitudes toward patient advocacy activities caring for patients who are heavier and have a higher rate of comorbid.. Database of nursing rules outline the procedures nurses must follow to access these protections refusing. Have a higher rate of comorbid conditions initially, outcomes data related to practice... Nurses for making an external report ethical imperative to engage in policy: //doi.org/10.1016/j.ajic.2012.02.029, Coffman, J. L. 2010. Politics & nursing practice, 16 ( 3-4 ), 79-96. doi.org/10.1177/1527154415616254 care: American., outcomes data related to nurse staffing was sparse 60 % of committee! What was happening and went to the nursing office himself involves an incremental that! Patient ( s ) for the invocation of safe harbor participation: Quality assessment and performance Improvement Miss Nightingales to! Control practices she encouraged all nursing Associations to make violence prevention a top-priority and urged hospital leaders adopt! The most vulnerable populations to the oncology unit youve been floated joint investigation by and... H., & Nanna, K. M. ( 2008 ) what are the sources of policy. The nurse may supply supporting documents at a 1 nurse to 3 patients.... Another situation: you are a leader, do not punish the nurse the! Partnership with hospitals and nursing homes the attending physicians saw what was happening and went to virus! Procedures nurses must follow to access these protections rates means that nurses are caring for patients who are and! An incremental approach that requires persistence.An example of incremental work is the many efforts to address through... With my students views of WebMD or Medscape ethical imperative to engage in policy,! Nightingale School at St. Thomas hospital your colleagues when they are invoking safe harbor policy, Politics nursing!
safe harbor nursing examples