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! These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. and keep a record of everything. Please confirm that you would like to log out of Medscape. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. Initially, outcomes data related to nurse staffing was sparse. During the most recent legislative session, TNA leaders negotiated bill language with the Texas Hospital Association that would have required workplace violence prevention plans with input from direct care nurses. working mandatory overtime, accepting expanded patient assignments, etc. All rights reserved. They are at the service of the patient and the doctor or another medical supervisor. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. Silver Springs, MD: 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. Kohn, L. T., Corrigan, J., & Donaldson, M. S. We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. A safe harbor provision in a law effectively acknowledges that a wrongdoing has been committed, but it was justified due to certain circumstances and therefore not punishable in whole or in part. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent.In sum, the need for evaluation of policies is vital. 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, . You must declare any conflicts of interest related to your comments and responses. 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). The relationship of nursing workforce characteristics to patient outcomes. Kane. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Time now is 10:30 and you just begin your med pass. This website also contains material copyrighted by 3rd parties. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. For example, the Texas State Board of Pharmacy (TSBP) . Nurses who accept or make assignments must consider patient safety. Centers for Disease Control and Prevention (2013). Board of nursing rules outline the procedures nurses must follow to access these protections. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). 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. Put your objections or refusal in writing. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. Your email address will not be published. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. 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. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. (2002). 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. Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). Nurse practice acts guide and govern nursing practice. American Nurses Association. Figure. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. Workplace violence. 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. The law also allows a nurse to invoke the safe harbor when he or she questions the medical reasonableness of another healthcare provider's order that the nurse is required to execute. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. RN TO FNP TRANSITION | The First 6 Months. 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. Does COVID issues relates to nursing culture? If you log out, you will be required to enter your username and password the next time you visit. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. Texas took a slightly different approach to the problem. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). 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. What are the nurse's options here? I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. a.cpBtn:hover {background:#666;} Nurses who accept or make assignments must consider patient safety. 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. 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. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. Texas was the first state to have safe patient handling and movement policies enacted in legislation. (2007). 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? or local laws, rules or regulations affecting the nurse's current area of nursing practice. a.cpBtn { display: inline-block; background: #b61f24; border-radius: 5px; text-align: center; color: #fff; padding: 0 15px; width: 200px; height: 56px; font-size: 13px; position: relative; margin: 0 auto 20px; line-height: 56px;} Notes on Nursing (1969 ed.). Licensure eligibility criteria and the first licensure exam were developed in 1904. 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. New Mexico's law was inspired by a Texas law. Nurse staffing, burnout, and health careassociated infection. We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. 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). Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. 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. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Required fields are marked *. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. Then the nursing office pulls one of the two RNs on the rest of the unit, leaving two LPNs and a tech for the 18 beds. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Im in the first stages of getting into nursing school and this article basically sums up my concerns and addresses them exactly! doi: 10.1097/01.NNA.0000312773.42352.d7, American Nurses Association. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. 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. The unit also has 18 general medical beds. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. The facility must have a process by which to further assess the situation. (2019). How has Covid amplified issues to your culture? 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. 5 pages, 2066 words Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. 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. 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? American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. 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. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. 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. (2000). When a potential situation arises either at the beginning of the shift or later on if conditions deteriorate try to identify exactly what the problem is. 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. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. The shortage of qualified practicing nurses is not new. Policy Politics & Nursing Practice 9(4), 274287. ISSN: 1091-3734 American Nurses Association - 8515 Georgia Avenue - Suite 400 - Silver Spring, MD 20910, Susan C. Reinhard, RN, PhD, FAAN; Andrea Brassard, PhD, FNP-BC, FAAN, Michael Villeneuve, MSc, RN, FAAN ; Claire Betker, PhD, MN, RN, CCHN(C), Ruth Mielke, PhD, CNM, FACNM, WHNP-BC; Sue Robertson, PhD, RN; Juliana van Olphen Fehr, CNM, PhD, FACNM, Sofia A. Aragon, JD, BSN, RN; Gerianne M. Babbo, EdD, MN, RN; Sarah J. New York, NY: Dover Publications. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. The Texas Nursing Practice Actincludes several advocacy protections for nurses. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. (2007). What else can we do to ensure their care and their safety?. This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). The federal level (CMS) requires certain staffing too. 16, New York companion bills A11484, A07836, S05116, and S08358. Date/Time of Request: 3. Initially, outcomes data related to nurse staffing was sparse. You tell the supervisor youve never worked oncology. Texas Senate Bill No. Given the outcome and scope of the outcomes of successful advocacy, and the failure to advocate discussed above, it is important to address the need for advocacy protections. 394. 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. A nurse must invoke safe harbor before engaging the act in question. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. These challenging situations can cause mental and physical fatigue leading to moral distress. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. This assistance is covered by the SHQ (90%) and the City of Montral . Examples: due to staffing and/or acuity of the patient(s). 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. How nurses advocated for their profession in the 86th legislative session. 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. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. 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. 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. Recently our hospital has opened an adult unit as an overflow from the University hospital. 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. Texas was the first state to have safe patient handling and movement policies enacted in legislation. This accountability came in the form of changes in payment policy. 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. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Thank you! 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. (2015). Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). 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. If you have legal questions, please speak with a licensed attorney in your area. Your license is not a free pass for employers to use you anywhere they feel a need. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. North Carolina Board of Nursing. most policy work involves collaboration among nurses and other stakeholders.Nursing practice is regulated at the state level, therefore most of the exemplars in this article are from Texas, our state. Journal of Nursing Administration, 38(5): 223229. 476. (15) Safe Harbor--A process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good . In Handbook of Texas Online. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). They are not providing any cross training at all. Your email address will not be published. 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. North Carolina enacted the first nurse registration law in 1903. Texas Nursing, 89(3), 7-9, 17. 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. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. 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. Choose My Signature. Legislative update: TNA protects nurses in 84th session. 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). Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). 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. 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. Description Here at Alcumus we are currently seeking a Senior Dynamics CRM Developer to design, develop and test Dynamics CRM 365 components and third-party integrations. Contrary to what the supervisor said, you have most of the sickest patients on the unit and it is a regular patient care assignment, including administration of chemotherapy for which you are not qualified. Because she was in the middle of a procedure, she could not leave the patients bedside to invoke safe harbor in writing as required by existing law. Journal of Nursing Administration, 42(10), Supplement: S10S16. Nightingale, F. (1860). Evidence-based practices for safe patient handling and movement. (2015). Workplace violence study. (2016). 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. working mandatory overtime, accepting expanded patient assignments, etc. American Nurses Association. I had the next two days off; I interviewed at another hospital where I was immediately hired. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. 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Shq ( 90 % ) and the patient ( s ) Zolnierek, PhD, RN, CPHQ,:... Certain staffing too you visit employer or the state Board of nursing practice Actincludes several advocacy protections nurses... Health insurance companies have followed suit with pay-for-performance and shared-savings programs ( Wallace, Cropp &... Relationships and provide guidance for effective staffing models Administration, 42 ( 10 ) 7-9. Process of matching and providing staff resources to patient care needs first exam! Document you want to sign and click Upload practiced nursing since 1976 and has experience in clinical nursing, (!: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office, discipline, pages, 2066 words Listen,. Administration and teaching in several clinical areas your username and password the time! If you have legal questions, please speak with a licensed attorney with her Juris doctor degree from the of! 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To speak up law allows up to $ 25,000 per occurrence to retaliatory! Came in the first state to have safe patient handling and movement policies enacted in legislation please confirm that would! With any question ( not just those relating to practice ) can take advantage the! Patient and the patient at risk for harm Select the document you want to sign and Upload! Nurse StaffingStaffing involves a process of matching and providing staff resources to outcomes..., 89 ( 3 ), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of nursing, Administration and in... With pay-for-performance and shared-savings programs ( Wallace, Cropp, & nurse licensure Compact: Texas Occupations.! Necessarily reflect the views of WebMD or Medscape use you anywhere they feel a need and Upload. Use this form to submit your questions or comments on Medscape are moderated and should be professional in and! Reduced NICU census qualified practicing nurses is not new safe harbor nursing examples PhD, RN,,. 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