Good luck! This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. World Health Organization. This assistance is covered by the SHQ (90%) and the City of Montral . R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. 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. Required fields are marked *. Initially, outcomes data related to nurse staffing was sparse. 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. Texas House Bill No. 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. 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. 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. London: MacMillan and Company. 476. 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. 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? 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. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. All rights reserved. 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. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). Washington, DC: National Academy Press. 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. (2013). (2015). American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. I am concerned for the patients safety and I need your help to find a safer way to take care of these patients. I cannot accept this assignment because my lack of knowledge or experience will put these patients at risk of harm. 394. Our hospital is expected to staff this unit. 16, New York companion bills A11484, A07836, S05116, and S08358. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. Safe Harbor Nursing Peer Review (Texas Occupations Code 303.005, 2019) protects nurses who believe in good faith that they are being requested to engage in conduct that would violate a nurses duty to patient as defined in the board of nursing rules on standards of professional practice and unprofessional conduct. The facility must have a process by which to further assess the situation. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Every nurse should be aware of the statutes and rules governing their profession. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. (2009). (2003). This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". She is active in policy development, actively negotiating legislative approaches to address nursings agenda. 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. Examples: due to staffing and/or acuity of the patient(s). The Figure offers additional information about Texas patient advocacy and whistleblower protections. Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. The ICU wants to give you a new patient and things are going from bad to worse. Workplace violence. This article is not legal advice. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). a.cpBtn:hover {background:#666;} 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. 192: Section 301.413(b-1). 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. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. 6, ANA, 2009). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). 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). 2410. or local laws, rules or regulations affecting the nurse's current area of nursing practice. https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. 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. 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. Every nurse should be aware of the statutes and rules governing their profession. Does COVID issues relates to nursing culture? You will receive email when new content is published. 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. It is remarkable to reflect on the first nurse practice acts and consider that those empowered nurses advanced the profession more than a decade before women even had the right to vote. 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. Centers for Disease Control and Prevention (2013). 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). 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. 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. Your license is not a free pass for employers to use you anywhere they feel a need. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). A medical director or member of the medical staff must determine whether the order was reasonable. Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). Willmann, J. Texas took a slightly different approach to the problem. California Assembly Bill No. Any request for safe harbor, be it on this form or 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.. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations.Hospitals were compelled to focus specifically on safety when in 1999 the Institute of Medicine (IOM) released its groundbreaking report, To Err is Human (Kohn, Corrigan, & Donaldson, 2000). This provision is called Safe Harbor. 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. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. What do you do? (2007). Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. 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. 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). Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. You tell the supervisor youve never worked oncology. 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://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. 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. 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. The hospital broke the law when it retaliated against the nurses for making an external report. Texas Nursing Voice, 7(3): 1, 3-4. for Nursing Education. 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 profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Think about it this way: if you were a new airplane mechanic and were assigned to work solo on a new type of engine that you havent seen before, knowing that the plane was due to fly over 300 passengers and crew in 2 hours, would you do it without objection? This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. 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. 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. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. Good luck! Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. They are not providing any cross training at all. Responding to a disaster is a familiar process for several nurses in Texas. Your email address will not be published. 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. (1997). 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. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. 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. 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