Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. A new law in New Mexico gives nurses another option. 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 Figure offers additional information about Texas patient advocacy and whistleblower protections. World Health Organization. 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. 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). Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. 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. 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. Thank you so much for this article! 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. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). As for the two examples at the beginning, they happened and I was the nurse. A medical director or member of the medical staff must determine whether the order was reasonable. 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. (2004). 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. Monthly Labor Review. 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. (Eds.). Why nurses need whistleblower protection. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. 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. In this case, all they need to do is write down the information listed above and hand it to a superior, letting them know that safe harbor is being requested. The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. Give a copy to your leader and keep a copy for yourself. For example, the Texas State Board of Pharmacy (TSBP) . Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. 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. Our hospital is expected to staff this unit. Then radiology is taking care of the patient FOR A SHORT TIME. Please confirm that you would like to log out of Medscape. (1997). 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. 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. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. You not only have all 6 step-down patients, you are now charge over the other 18 beds. Initially, outcomes data related to nurse staffing was sparse. 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. 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. Silver Springs, MD: American Nurses Association. Journal of Nursing Administration, 38(5): 223229. This is such an unsafe situation for everyone. The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. B. doi: 10.1177/1527154408319287. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 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. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. Texas Nursing Voice, 7(3): 1, 3-4. 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. Your email address will not be published. Nelson, A., & Baptiste, A. S. (2006). Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. 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). Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Initially, outcomes data related to nurse staffing was sparse. However, we recognize that there are stories from every state that highlight the valuable work of many nurses that illustrate individual and collective nursing organization advocacy. Nurses are often called to respond to disasters. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. 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. Examples: due to staffing and/or acuity of the patient(s). 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. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). No nurse, from a patient safety and legal liability standpoint, should ever be assigned primary care responsibility for patients that they are unqualified to care for yes, your license says you MAY care for these patients BUT that is only AFTER youve had training and supervision. Nurse(s) Name(s) invoking Safe Harbor: 2. Yours is a specialization and you cant be transplanted to another area imagine if any of the adult care nurses were suddenly told they had to care for NICU patients without training and supervision. Figure. State facts, include the date and time, and why you are refusing or objecting. Any request for safe harbor, be it on this form or Historical Information. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. The tenants of this project will benefit from the Rent Supplement Program, which will allow them to spend only 25% of their gross income on housing. We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. (2013). Invoking safe harbor shouldn't change anything. Often policy change involves an incremental approach that requires persistence. 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! Nursing enjoys successful session: 2013 legislative session from a nursing perspective. 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 . 61-3A-1. This provision is called Safe Harbor. (2009). I am so sorry you are going through this. Policy Politics & Nursing Practice 9(4), 274287. For example, a telemetry unit in one small community hospital can compare its pressure ulcer and vacancy rates to a similar unit in another community hospital. 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. They are not providing any cross training at all. 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 . A place where registered nurses and nurse practitioners offer helpful videos and articles and advice to other nurses. 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. Discussions of nurse staffing followed these trends. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. (2015). 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. Code of ethics with interpretive statements. 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