safe harbor nursing examples

This example represents a missed opportunity for nurses to change practice through policy. Orthopedic Nursing, 25(6), 366-379. Nurses dont always have a lot of authority on the floor, so they need to learn how to protect themselves if someone asks them to do something that goes against their ethics or the law. 394. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. This accountability came in the form of changes in payment policy. We conclude by considering implications for nursing organizations and nurses among these exemplars. By mid-morning, you have two disoriented step-down patients, including one who pulls out his IV and fights with his family, and your LPNs cant give IV meds. Nurse staffing advocacy. 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 . Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. 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Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. 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. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? Initially, outcomes data related to nurse staffing was sparse. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. 2022 American Nurses Association. Thank you for your comment. 25, No. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. Nursing safe harbor is a law that nurses can use to absolve themselves of liability when forced to commit an act that the nurse believes violates Texas Board Statutes and Rules. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. (2011). Texas Nursing Voice, 7(3): 1, 3-4. (2015). Why nurses need whistleblower protection. 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. Create your signature and click Ok. Press Done. Solving tough problems through innovation and proven methodology. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} Are you unqualified to care for the patients assigned? Give a copy to your leader and keep a copy for yourself. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. 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.. Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). Licensure eligibility criteria and the first licensure exam were developed in 1904. and keep a record of everything. Willmann, J. Thank you so much for this article! As for the two examples at the beginning, they happened and I was the nurse. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. 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. We 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 in our state. Neither are nurses legal, professional, and ethical duties. How nurses advocated for their profession in the 86th legislative session. 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). This law requires hospitals and nursing homes to adopt policies and procedures for the safe handling of patients that control the risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. (Texas Senate Bill 1525, 2005). 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. Silver Springs, MD: American Nurses Association. If a patient, supervisor or doctor asks the nurse to violate one of these rules, the nurse can invoke safe harbor before committing the act to ensure that they arent held legally responsible for what happens next. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. Decades of research have confirmed the relationship between nurse staffing and patient outcomes such as mortality (Aiken et al., 2012; Aiken, Clarke, Sloane, Lake, & Cheney, 2008), healthcare-associated infections (Cimiotti, Aiken, Sloane, & Wu, 2012), financial, and nurse outcomes (Unruh, 2008). (2003). Workplace violence study. (2007). a.cpBtn:hover {background:#666;} 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. 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). Nurses have been advocating for change since the day Florence Nightingale penned an urgent missive to the Secretary of State for War on the need for trained nurses to care for the wounded soldiers in the Crimea. (2007). 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. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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. 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. Texas Senate Bill No. What do you do? The Texas process has been criticized as cumbersome in emergency situations. 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. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. Effects of hospital care environment on patient mortality and nurse outcomes. 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. 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. The ICU wants to give you a new patient and things are going from bad to worse. You not only have all 6 step-down patients, you are now charge over the other 18 beds. The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances. Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. Online Journal of Issues in Nursing, 9(3). (2019, January 30). The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. 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. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. I work at a Childrens and Womens hospital. 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 https://www.nursingworld.org/ana/about-ana/history/. 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. 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. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. To err is human: Building a safer health system. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. Nurse staffing, burnout, and health careassociated infection. Decide on what kind of signature to create. 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. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. B. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. Nurses are warm, compassionate and forgiving to a fault. 1525. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, Jones, T., Bae, S. H., & Murry, N. (2015). (BJ) Strickland is from Tennessee. 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. We discuss this in the context of practice in the state of Texas. These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy most policy work involves collaboration among nurses and other stakeholders. In Handbook of Texas Online. A., & Spetz, J. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. doi: 10.1177/1527154408319287. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. Montalvo, I. Nightingale, F. (1914). Consider another situation: You are an experienced nurse. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes.Such policies directly support nurse executives, often the decision-makers related to staffing, by offering a flexible approach to planning and budgeting nursing services. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). Often policy change involves an incremental approach that requires persistence. New Mexico's law was inspired by a Texas law. Historical Information. The unit also has 18 general medical beds. A nurse must invoke safe harbor before engaging the act in question. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). The nursing supervisor calls and tells you to go to the oncology unit youve been floated. (2019). HB 2696 provided authority for the Texas Center of Nursing Workforce Studies to conduct a survey both healthcare organizations and nurses about their experiences with workplace violence (Cates, 2015). These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. They are not providing any cross training at all. Nurses can find themselves in all kinds or risky or potentially dangerous situations. 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). Is the assignment outside the scope of your practice or your experience and knowledge level? All rights reserved. I appreciate the legal advice. 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. 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. Every nurse should be aware of the statutes and rules governing their profession. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). Texas Senate Bill No. We are looking for someone to be able to work closely with our business end . (2019). Texas Senate Bill No. 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. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. Good luck! The ANA position statement is an excellent resource to start. Initially, outcomes data related to nurse staffing was sparse. This is retaliation and it is barred by law and professional practice rules. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. 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. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Nurse practice acts guide and govern nursing practice. 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. This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. Kudzma, E. C. (2006). Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. (2004). Remember that it could be you or a loved one in the patient room someday. My apologies for not answering sooner. The federal level (CMS) requires certain staffing too. 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. Journal of Nursing Administration, 42(10), Supplement: S10S16. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Beth J. 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? Taylor, J. L. (2010). 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. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 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. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. 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). Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). 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. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Figure. The hospital broke the law when it retaliated against the nurses for making an external report. You've successfully added to your alerts. As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. Refuse the assignment, and face disciplinary action? Monthly Labor Review. 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. 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. 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.

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