My question is this. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. 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. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it. 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. The facility must have a process by which to further assess the situation. A brief history of Florence Nightingale and her real legacy, a revolution in public health. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. (1997). Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). 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). 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. You've successfully added to your alerts. The ICU wants to give you a new patient and things are going from bad to worse. 6, ANA, 2009). Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. If you are a leader, do not punish the nurse objecting or refusing the assignment. I work at a Childrens and Womens hospital. (2015). The shortage of qualified practicing nurses is not new. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). General Information About Safe Harbor; The Texas Board of Nursing (BON or Board) has safe harbor nursing peer review forms available to make the process faster and easier for a nurse who believes he/she is being asked to accept an unsafe assignment, engage in conduct beyond his/her scope of practice, or engage in unprofessional or illegal conduct. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. Online Journal of Issues in Nursing, 9(3). Put your objections or refusal in writing. 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. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. If were talking about a full-shift assignment, the facility is setting itself up for a malpractice suit and likely sanctions from the licensing/accrediting body, which could result in large fines, even revocation of Medicare status. Every nurse should be aware of the statutes and rules governing their profession. 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. 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). Journal of Nursing Administration, 38(5): 223229. I am not qualified to care for these patients because I dont have the knowledge or the experience. 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. 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. Board of nursing rules outline the procedures nurses must follow to access these protections. 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. 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 . or local laws, rules or regulations affecting the nurse's current area of nursing practice. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . (1999). 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.. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). 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. State facts, include the date and time, and why you are refusing or objecting. I have worked NICU for 31 years. My apologies for not answering sooner. While many nurses recognized the reuse practice as inconsistent with safe infection control practices, complacency among coworkers and fear of retaliation inhibited reporting of concerns. New York, NY: Dover Publications. Initially, outcomes data related to nurse staffing was sparse. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Nurses can find themselves in all kinds or risky or potentially dangerous situations. During the most recent legislative session, TNA leaders negotiated bill language with the Texas Hospital Association that would have required workplace violence prevention plans with input from direct care nurses. We conclude by considering implications for nursing organizations and nurses among these exemplars. Decide on what kind of signature to create. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. 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. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. Texas Senate Bill No. Centers for Disease Control and Prevention (2013). Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. 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. Nurses who accept or make assignments must consider patient safety. a Supervisor in Kindred Hospital in West Minister California has a Habit of assigning RN to a patient in 2 different departments, So when a call light is on 1 patient , you cannot see or hear your other patient, And if refuse this assignment , you are reprimanded by your superiors, The CNA rep also has no idea to battle this on going problem. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. American Nurses Association. In Handbook of Texas Online. a.cpBtn { display: inline-block; background: #b61f24; border-radius: 5px; text-align: center; color: #fff; padding: 0 15px; width: 200px; height: 56px; font-size: 13px; position: relative; margin: 0 auto 20px; line-height: 56px;} 2410. 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). 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. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. 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? Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. HB 2696 provided authority for the Texas Center of Nursing Workforce Studies to conduct a survey both healthcare organizations and nurses about their experiences with workplace violence (Cates, 2015). When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. Click the topic below to receive emails when new articles are available. Orthopedic Nursing, 25(6), 366-379. 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. The Texas law applies to employers of eight or more nurses. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. 192: Section 301.413(b-1). Nurse staffing, burnout, and health careassociated infection. The law allows a nurse to reject an assignment on the basis of the nurse's assessment of his or her education, knowledge, competence, or experience and the nurse's immediate assessment of the risk for patient safety, or violation of the Nurse Practice Act or Board of Nursing rules. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). doi: 10.1097/01.NNA.0000312773.42352.d7, American Nurses Association. (2002). Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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. We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. 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. The history of the American Nurses Association. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. They are at the service of the patient and the doctor or another medical supervisor. 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. 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 . 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. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. 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). 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). All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Examples: due to staffing and/or acuity of the patient(s). The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. Protections are imperfect, but that does not diminish their importance. Remember that it could be you or a loved one in the patient room someday. Invoking safe harbor shouldn't change anything. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. 25, No. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. working mandatory overtime, accepting expanded patient assignments, etc. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy by addressing systemic barriers to optimal patient care and healthy environments through establishment of standards, regulations, and policy. 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). Although the organizational policy changes that result from implementation of grant programs may help protect the nurses who work the facilities awarded grant funds, widespread protections remain elusive despite a decade of advocacy. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. 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. Refuse the assignment, and face disciplinary action? A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. 5 pages, 2066 words Washington, DC: American Nurses Publishing. Willmann, J. Nelson, A., & Baptiste, A. S. (2006). 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