Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. 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. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). Notify me of follow-up comments by email. The facility must have a process by which to further assess the situation. 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). Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Input from nurses is the foundation of this advocacy work to identify the need for policy change and make the case for why change is needed. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. 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. This was the latest of many staffing incidents at this facility. Texas Board of Nursing (TBON, n.d.a) clarifies Safe Harbor as a nursing peer review process the nurse may initiate, under good faith, when asked to engage in assignments or conduct the nurse believes to violate Standards of Practice, Duty to Patient, or . 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. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. 2022 American Nurses Association. 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. (1997). Neither are nurses legal, professional, and ethical duties. Dont use subjective or accusatory terms such as short-staffing. Sign it. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. 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. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices. Solving tough problems through innovation and proven methodology. 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. Texas was the first state to have safe patient handling and movement policies enacted in legislation. Texas Nurses Association. Silver Springs, MD: American Nurses Association. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. 5 pages, 2066 words 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. (2019). Washington, DC: National Academy Press. (BJ) Strickland is from Tennessee. I appreciate the legal advice. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. 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. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). Click the topic below to receive emails when new articles are available. 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. American Nurses Association. 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. 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. 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). For the first time, patient outcomes could be specifically mapped to nursing care, not just by morbidity or medical complications, but by outcomes that are specifically amenable to nursing management and intervention. For example, a primary care physician and a specialist to whom the . Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. A nurse may not feel as if they have the option of saying no or refusing to engage in these kinds of situations, so invoking safe harbor may be their only choice. Kane. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. 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. The statute was implemented in 2004. Nurses who accept or make assignments must consider patient safety. 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. 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. 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. If you log out, you will be required to enter your username and password the next time you visit. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. How nurses advocated for their profession in the 86th legislative session. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). 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. (2000). 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? My question is this. Nurses are often called to respond to disasters. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. Workplace violence study. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. 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. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). Ask for help and help your colleagues when they are facing an unsafe assignment. Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). 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. 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. Why nurses need whistleblower protection. (Eds.). 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. 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. Even if you have never been in questionable situation, you should know your organizations policies and your states laws and regulations regarding refusing an assignment. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Or go, try, risk making a mistake, and hope for the best? Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. A., & Spetz, J. You cannot be responsible for patients in 2 different locations (units, departments) at the same time UNLESS a qualified provider is covering the other patient. Nurse staffing, burnout, and health careassociated infection. or local laws, rules or regulations affecting the nurse's current area of nursing practice. 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. NPAs have not remained stagnant over the past century, rather they have evolved but only with the active involvement of nurses in legislative efforts to change statute and update policies related to nursing practice. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Texas House Bill No. Medical Care, 45(12), 1195-1204. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Initially, outcomes data related to nurse staffing was sparse. 25, No. please help the nurses reason legally to this unsafe patient services. Discussions of nurse staffing followed these trends. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. This provision is called Safe Harbor. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Online Journal of Issues in Nursing, 12(3). 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. 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. Revision of the code in 1995 expanded it to include social ethics, global concerns, and emphasis on the important role of nurses in health policy. Refuse the assignment, and face disciplinary action? New Mexico's law was inspired by a Texas law. 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. In 2010, Texas emergency department nurse Jessica Taylor authored a commentary in the American Journal of Nursing about her experience of being assaulted at work (Taylor, 2010). London: MacMillan and Company. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. Recently our hospital has opened an adult unit as an overflow from the University hospital. 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). Thank you for your comment. 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! And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. Put your objections or refusal in writing. 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. working mandatory overtime, accepting expanded patient assignments, etc. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". She retired from the U.S. Army in 2015 as a Lieutenant Colonel. American Nurses Association. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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.

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