This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". Safe patient handling U.S. enacted legislation snapshot. Nurse staffing and patient, nurse, and financial outcomes. 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.. 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. The Texas Nursing Practice Actincludes several advocacy protections for nurses. Nurses can find themselves in all kinds or risky or potentially dangerous situations. 25, No. (2011). Often policy change involves an incremental approach that requires persistence. (2011). (2019). The ICU wants to give you a new patient and things are going from bad to worse. Cates, A. 476. 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). To err is human: Building a safer health system. doi: 10.1177/1527154408319287. This database includes measures directly related to nursing care and patient outcomes (Montalvo, 2007) such as: nursing hours per patient days; hospital-acquired infections and pressure ulcers; and skill mix (percent of total nursing hours supplied by different types of direct care providers). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. (North Carolina Board of Nursing, 2019). The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. Recently our hospital has opened an adult unit as an overflow from the University hospital. 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. 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. Retrieved from https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, Texas Legislature Online. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. Texas Senate Bill No. Evidence-based practices for safe patient handling and movement. I had the next two days off; I interviewed at another hospital where I was immediately hired. 2011 Session: A roller coaster ride for nursing. 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. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. Small, H. (2017). Name of person/supervisor (and title) making assignment or requesting the conduct: 5. COMPREHENSIVE REQUEST FOR NURSING SAFE HARBOR PEER REVIEW (SHPR) NOTE: ONLY SECTION I (pages 3-6) MUST BE COMPLETED BY THE NURSE WHEN INITIALLY INVOKING SAFE HARBOR A nurse's request for Safe Harbor Must be in Writing, however, use of this form is not required for a nurse to invoke Safe Harbor. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). New York, NY: Dover Publications. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. Where creative models of care to reduce costs dominated dialogue around nurse staffing in the 1990s, attention was cued to staffing outcomes following the IOM report. The federal level (CMS) requires certain staffing too. 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. 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. 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. (Dressner & Kissinger, 2018). This article is not legal advice. She is an RN with Bachelors and Masters degrees in nursing and a Masters degree in history from Vanderbilt University. 24-Hour. 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. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . 394. (2013). Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. Safe Harbor for Nurses . Remember that it could be you or a loved one in the patient room someday. (2015). (2016). Good luck! (1999). They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. The relationship of nursing workforce characteristics to patient outcomes. SAFE HABOUR COMPREHENSIVE REQUEST FOR NURSING SAFE HARBOR PEER REVIEW (SHPR) ONLY SECTION I (pages 3-6) MUST BECOMPLETED BY THE NURSE WHEN INITIALLY INVOKING SAFE HARBOR A nurse's request for Safe Harbor Must be in Writing, however, use of this form is not required for a nurse to invoke Safe Harbor. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. 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. 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 . Texas Nurses Association. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. 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. They are at the service of the patient and the doctor or another medical supervisor. 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. World Health Organization. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. 192: Section 301.413(b-1). These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). Nurse staffing advocacy. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. If you log out, you will be required to enter your username and password the next time you visit. The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. 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. They can use a Quick Request Form from the Board of Nursings website or any document as long as it contains the following information: Nurses may not have the time or resources to properly fill out the correct form when asked to engage in an assignment that may violate Board Statutes and Rules. 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. B. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). My question is this. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. The nursing office says it has no one to help you for at least another 4 hours, if that. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. (2004). 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. 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). Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. 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. 394, 1999). Minimum nurse-to-patient ratios in acute care hospitals in California. I am so sorry you are going through this. I hope youll never need it but under current circumstances, you may. The National Database of Nursing Quality IndicatorsTM (NDNQI). If you dont have your own malpractice/professional liability insurance, you should invest in coverage immediately because the facility will likely try to shift blame for any patient injuries or deaths to the individual nurse. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? I got some help. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. Safe Harbor Forms - Nursing Peer Review. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. State facts, include the date and time, and why you are refusing or objecting. 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: We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. This assistance is covered by the SHQ (90%) and the City of Montral . Please confirm that you would like to log out of Medscape. Required fields are marked *. 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. I appreciate the legal advice. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Safe patient handling and mobility. 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. 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. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Nightingale, F. (1860). 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. American Nurses Association. Board Rule 217.20 is the Board's rule concerning safe harbor nursing peer review, and 217.20(e) outlines the requirements the nurse must meet in order to secure the protections, . Initially, outcomes data related to nurse staffing was sparse. The supervisor can be legally held liable for failure to properly assign, supervise, delegate and so could the hospital in the event of patient injury or death. 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. Texas House Bill No. (n.d.). Short title. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Solving tough problems through innovation and proven methodology. Invoking safe harbor shouldn't change anything. Notes on Nursing (1969 ed.). Legislative update: TNA protects nurses in 84th session. Ask for help and help your colleagues when they are facing an unsafe assignment. Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. 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). please help the nurses reason legally to this unsafe patient services. 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. My apologies for not answering sooner. 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. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). Nurses are not always in control of the care they provide, so its important that everyone understands the terms of safe harbor and when it may be invoked. Willmann, J. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. The facility must have a process by which to further assess the situation. 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. Registered nurses experience musculoskeletal injuries at a rate of 46.0 cases per 10,000 full-time workers, much higher than the rate for all occupations, 29.4 cases per 10,000 workers based on data from the U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses. This accountability came in the form of changes in payment policy. 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. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. Thank you for your comment. Figure. A medical director or member of the medical staff must determine whether the order was reasonable. for Nursing Education. 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. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Nurses are often called to respond to disasters. Texas nurse staffing trends before and after mandated nurse staffing committees. Online Journal of Issues in Nursing, 12(3). Nurse(s) Name(s) invoking Safe Harbor: 2. legislators had difficulty appreciating the reality of violence in healthcare settings.The compelling study results were published in 2016 (Texas Department of State Health Services, 2016) and the data supported efforts to pass legislation (HB 280) that funded grants for innovative approaches to reduce workplace violence in health care organizations. A joint investigation by federal and state agencies revealed violation of standard infection control practices. 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. Or go, try, risk making a mistake, and hope for the best? In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports.Nurses know that a culture supporting collaborative, interdisciplinary practice that encourages both identification and reporting of problems and barriers to care delivery leads to optimum patient and nurse outcomes. 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 . 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). 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. What are the nurse's options here? Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. 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. 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. Imagine this scenario: A nurse who has worked for 2 years in an adult medical-surgical unit reports for work and learns that she is assigned to work in neonatal intensive care that day. In Texas, it is called the safe harbor provision and other states, although they may not use that term, have similar policies or statutory wording. Thank you for this article. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. (2007). I work at a Childrens and Womens hospital. Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . Workplace violence study. 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. As gaps in protection are identified, nurses work to address them through policy change. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. 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. All rights reserved. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). After the hard work is finished and the policy becomes how we practice, the origin stories are lost, and progress is often taken for granted. Examples: due to staffing and/or acuity of the patient(s). 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. Scope of the situation Nelson & Baptiste, 2006 ), the Texas Board! The City of Montral https: //www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., &,. 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