These challenging situations can cause mental and physical fatigue leading to moral distress. 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. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. 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. The nursing office says it has no one to help you for at least another 4 hours, if that. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. 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? 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. (2019). Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. Safe patient handling and mobility. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. We discuss this in the context of practice in the state of Texas. The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. Montalvo, I. 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. 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. 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. Although both bills failed to pass in 2011 (Willmann, 2011), similar legislation enhancing penalties for assault of emergency department personnel passed in the next legislative session (Willmann, 2013). The NDNQI provided one of the first databases of patient and nurse outcome indicators and it is currently the only national database containing unit level data regarding nurse sensitive indicators. 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). (Eds.). This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. 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. North Carolina Board of Nursing. Monthly Labor Review. 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;} 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. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. I have worked NICU for 31 years. 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. Protections are imperfect, but that does not diminish their importance. A joint investigation by federal and state agencies revealed violation of standard infection control practices. Zolnierek, C. (2019). The facility may not retaliate against the nurse who invokes the safe harbor. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. 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. Nurses have an ethical imperative to engage in policy. This article is not legal advice. Why nurses need whistleblower protection. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. Your email address will not be published. The unit also has 18 general medical beds. The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. 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. American Nurses Association. Ask for help and help your colleagues when they are facing an unsafe assignment. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. Texas Senate Bill No. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. Initially, outcomes data related to nurse staffing was sparse. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. 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. 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. 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). This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". Texas House Bill No. (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 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). All rights reserved. Thank you! Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. I had the next two days off; I interviewed at another hospital where I was immediately hired. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. I am not qualified to care for these patients because I dont have the knowledge or the experience. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. Kohn, L. T., Corrigan, J., & Donaldson, M. S. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. Please confirm that you would like to log out of Medscape. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. Location of requested conduct/assignment: 4. You tell the supervisor youve never worked oncology. Table. 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. If you were an internal medicine physician and told that you, as the only doctor available, had to perform a craniotomy, would you do it? Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. 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). 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. 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. 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. Licensure eligibility criteria and the first licensure exam were developed in 1904. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. 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. 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. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . It is Christmas Eve and you report to your unit to work the night shift. Washington, DC: National Academy Press. Initially, outcomes data related to nurse staffing was sparse. 1, Manuscript 2. New York, NY: Dover Publications. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. (1999). 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. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. 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. doi: 10.1177/1527154408319287. 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. Invoking safe harbor shouldn't change anything. 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. To ensure policies are effective, the impact on nursing practice must be evaluated to make certain policies are having the desired effect and have not created unintended consequences. 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. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. Nurse staffing and patient, nurse, and financial outcomes. 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. A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Nursing workload and hospital work environment variables, including culture, have a significant impact on the ability of the nurse to provide safe and appropriate care (Kane et al., 2007; Unruh, 2008). The National Database of Nursing Quality IndicatorsTM (NDNQI). These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . The Texas Nursing Practice Actincludes several advocacy protections for nurses. The risks are not only damaging to the health of nurses and patients, but also are costly in terms workers compensation insurance and nurse turnover. This was the latest of many staffing incidents at this facility. They are at the service of the patient and the doctor or another medical supervisor. 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. Advocacy in Nursing Regulation: Nurse Practice ActsThe original intent of nurse practice acts was the regulation of nursing practice through registration, now licensure (Russell, 2012). The ANA position statement is an excellent resource to start. Your email address will not be published. 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. California Assembly Bill No. Nightingale, F. (1914). 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. 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. Often policy change involves an incremental approach that requires persistence. 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. 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. Silver Springs, MD: American Nurses Association. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. 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! However, changing practice through policy does not stop with the NPA. Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. 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. Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse.! About $ 10-12/month and many policies include a legal representation benefit if your BON tries discipline... Arising from conflicting values and ideals for the nursing office are the sources of health policy,,! In staffing decisions above are the sources of health policy, legislation, nurse act. 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