As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. 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. 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. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). 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. 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. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. Texas Nursing, 89(3), 7-9, 17. What do you do? Board of nursing rules outline the procedures nurses must follow to access these protections. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. 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. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. (2000). Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. 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. 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 . 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. 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. I agree! Decide on what kind of signature to create. (Eds.). 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. Table. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Consider another situation: You are an experienced nurse. Examples: due to staffing and/or acuity of the patient(s). Nightingale, F. (1860). 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. 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. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. (Read the story of how one nurse worked through TNA to make this possible.). Black noted that while nurses are accountable for protecting patients from harm, often few protections exist for nurses raising patient safety concerns: employment at-will doctrine places nurses who witness unsafe practices in a difficult catch-22: if they report unsafe practices, they risk losing their jobs; if they dont, they risk losing their licenses. (p. 28). If were talking about a full-shift assignment, the facility is setting itself up for a malpractice suit and likely sanctions from the licensing/accrediting body, which could result in large fines, even revocation of Medicare status. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. 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. These challenging situations can cause mental and physical fatigue leading to moral distress. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. Retrieved from https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, Texas Legislature Online. Taylor, J. L. (2010). She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. Centers for Disease Control and Prevention (2013). Safe Harbor for Nurses . As gaps in protection are identified, nurses work to address them through policy change. 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. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Neither are nurses legal, professional, and ethical duties. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. 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. Refuse the assignment, and face disciplinary action? You've successfully added to your alerts. Nurse staffing and patient, nurse, and financial outcomes. The statute was implemented in 2004. and keep a record of everything. New York, NY: Little, Brown Book Group. You fill out a form that basically says that your work environment is unsafe and you will continue to care for your patients to the best of your ability, but are not held responsible for mistakes that are made. (2012). Texas took a slightly different approach to the problem. Nurses have an ethical imperative to engage in policy. (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 . (2019). These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. The unit also has 18 general medical beds. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). 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). For example, the Texas State Board of Pharmacy (TSBP) . Initially, outcomes data related to nurse staffing was sparse. Invoking safe harbor shouldn't change anything. 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. The facility may not retaliate against the nurse who invokes the safe harbor. My question is this. 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. 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. Texas was the first state to have safe patient handling and movement policies enacted in legislation. For example, a primary care physician and a specialist to whom the . 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. Give a copy to your leader and keep a copy for yourself. New York, NY: Dover Publications. North Carolina enacted the first nurse registration law in 1903. Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. 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. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. A study examining the effect of Texas staffing legislation (Texas Senate Bill 476, 2009) found that hospitals with higher staffing levels did not significantly change after the legislation and hospitals the lowest staffing levels prior to the legislation increased staffing (Jones, Bae, and Murry, 2015). 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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