She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. 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. for Nursing Education. 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. Thank you for this article. 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: For example, dissatisfied with the staffing by patient acuity model legislated in the early 1990s, (Coffman, Seago, Spetz, 2002) members of the California Nurses Association successfully pressed 164 legislators to pass a prescriptive bill specifying the maximum number of patients to be assigned to a registered nurse in each patient care area (California Assembly Bill No. 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. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Historical Information. Please enter a Recipient Address and/or check the Send me a copy checkbox. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. 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. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. (2015). To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. Location of requested conduct/assignment: 4. (2012). The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). 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.. As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. Put your objections or refusal in writing. 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. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. 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. Safe Harbor Forms - Nursing Peer Review. 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. A brief history of Florence Nightingale and her real legacy, a revolution in public health. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Neither are nurses legal, professional, and ethical duties. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurses are often called to respond to disasters. The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. (North Carolina Board of Nursing, 2019). A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. Time now is 10:30 and you just begin your med pass. 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! The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. 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. North Carolina enacted the first nurse registration law in 1903. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). Nurse executives should support nurses who exercise their rights to protect their licenses and not view safe harbor requests as an affront to their leadership. 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? What do you do? You submit it to the BON. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. Then radiology is taking care of the patient FOR A SHORT TIME. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. (2009). The Figure offers additional information about Texas patient advocacy and whistleblower protections. 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). Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). 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? 476. The history of the American Nurses Association. 1525. This protects them from facing punitive measures from their employer, losing their nursing license or being sued in court for putting a patients life in danger. 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 . 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. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. 2011 Session: A roller coaster ride for nursing. 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. legislators had difficulty appreciating the reality of violence in healthcare settings. With the increasing body of evidence documenting the relationship between nurse staffing and patient outcomes, several states have passed legislation requiring organizations to adopt more specific policies and practices. As we begin 2020, designated by the World Health Organization ([WHO], 2019) as the Year of the Nurse and Midwife, policy change remains among the most effective approaches to create the circumstances for the right thing to be done. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. (2016). This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). 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. Texas took a slightly different approach to the problem. Nurses who accept or make assignments must consider patient safety. I strongly recommend contacting your state board of nursing, state nurses association, and the state facility licensing board to find out what their regulations are. a.cpBtn:hover {background:#666;} 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. 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. RN TO FNP TRANSITION | The First 6 Months. 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. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. (Dressner & Kissinger, 2018). (2019). Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? Short title. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). To err is human: Building a safer health system. 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. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. 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). The relationship of nursing workforce characteristics to patient outcomes. Montalvo, I. (2019). The hospital broke the law when it retaliated against the nurses for making an external report. Licensure eligibility criteria and the first licensure exam were developed in 1904. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". The ICU wants to give you a new patient and things are going from bad to worse. 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 had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. 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. 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, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. 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 Department of State Health Services fined the hospital the maximum allowable amount of $1,300 (Thomas & Willman, 2012). Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. 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. (BJ) Strickland is from Tennessee. Every nurse should be aware of the statutes and rules governing their profession. 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. What are the nurse's options here? Share cases and questions with Physicians on Medscape Consult. I got some help. Responding to a disaster is a familiar process for several nurses in Texas. Our hospital is expected to staff this unit. 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. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. Nurses are warm, compassionate and forgiving to a fault. 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. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. 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. Initially, outcomes data related to nurse staffing was sparse.Measurements of quality shifted away from an interest in structure and process, and instead targeted outcomes: patient, staff, and financial. 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. (2007). Initially, outcomes data related to nurse staffing was sparse. Figure. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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. Ask for help and help your colleagues when they are facing an unsafe assignment. A joint investigation by federal and state agencies revealed violation of standard infection control practices. Simultaneously, they may be worried about their family and loved ones. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Is the assignment outside the scope of your practice or your experience and knowledge level? Texas Senate Bill No. (2002). In Handbook of Texas Online. You will receive email when new content is published. As for the two examples at the beginning, they happened and I was the nurse. Notes on Nursing (1969 ed.). We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Silver Springs, MD: American Nurses Association. Unfortunately, the legal system is just, not fair. weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. They can use a. from the Board of Nursings website or any document as long as it contains the following information: The name of the nurses(s) making the safe harbor request and their signature(s), Time and date of when the request was made, The location of where the conduct or assignment is to be completed, The name of the person requesting the conduct or making the assignment, A brief explanation of why the nurse is invoking safe harbor, An assignment or conduct that constitutes a criminal act, An assignment that results in or requires unprofessional conduct, A situation in which the nurse lacks the basic knowledge, skills, and abilities necessary to deliver nursing care that is safe and that meets the minimum standards of care to such an extent that accepting the assignment would expose one or more patients to an unjustifiable risk of harm, 5 Valuable Lessons Every Nurse Must Learn on the Job, How Healthcare Workers Can Better Deal with Moral Distress in the Workplace. 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. Give a copy to your leader and keep a copy for yourself. All rights reserved. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. Commenting is limited to medical professionals. Im in the first stages of getting into nursing school and this article basically sums up my concerns and addresses them exactly! Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. As gaps in protection are identified, nurses work to address them through policy change. 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. 2410. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). State facts, include the date and time, and why you are refusing or objecting. or local laws, rules or regulations affecting the nurse's current area of nursing practice. The federal level (CMS) requires certain staffing too. (2004). (2005). I work at a Childrens and Womens hospital. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. 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. The ANA position statement is an excellent resource to start. 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). Standard infection control practices form of suck it up and do the you. Exonerated in a jury trial, nurse advocates went to work to strengthen protections! Incremental approach that requires persistence.An example of incremental work is the many to! Murry, N. ( 2015 ) med pass initially, outcomes data related to nurse staffing and education! Has experience in clinical nursing, 2019 ) workplace violence since 1976 and has experience in nursing... //Www.Bon.Texas.Gov/Pdfs/Law_Rules_Pdfs/Nursing_Practice_Act_Pdfs/Npa2019.Pdf, Texas Constitution and Statutes TNA practice hotline because she was against. 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