Since then, 11 states have either passed laws or promulgated regulations, 10 of which require healthcare facilities to develop and implement comprehensive safe patient handling programs (Brigham, 2015). New York, NY: Dover Publications. (Dressner & Kissinger, 2018). A new law in New Mexico gives nurses another option. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. 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. Thank you so much for this article! 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. Evidence-based practices for safe patient handling and movement. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. 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. Is the assignment outside the scope of your practice or your experience and knowledge level? 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 Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. 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. Key Words: nurse, nurse advocacy, health policy, legislation, nurse practice act, whistleblower. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. Protection failures represent opportunities for future advocacy. Put your objections or refusal in writing. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. They are at the service of the patient and the doctor or another medical supervisor. (2000). Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. You submit it to the BON. The supervisor can be legally held liable for failure to properly assign, supervise, delegate and so could the hospital in the event of patient injury or death. 1, Manuscript 2. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. 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). (2016). We are looking for someone to be able to work closely with our business end . 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. She doesn't think she can provide safe care to sick neonates, and says so to the supervisor, who tells her to go to the neonatal unit anyway. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. 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There are three variants; a typed, drawn or uploaded signature. I have worked NICU for 31 years. (2005). The history of the American Nurses Association. Nurse staffing and patient, nurse, and financial outcomes. How nurses advocated for their profession in the 86th legislative session. I hope youll never need it but under current circumstances, you may. Effects of hospital care environment on patient mortality and nurse outcomes. Examples: due to staffing and/or acuity of the patient(s). 2011 Session: A roller coaster ride for nursing. Texas Board of Nursing (TBON, n.d.a) clarifies Safe Harbor as a nursing peer review process the nurse may initiate, under good faith, when asked to engage in assignments or conduct the nurse believes to violate Standards of Practice, Duty to Patient, or . She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). 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. You will receive email when new content is published. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Texas Nurses Association. Other states have passed legislation (ANA, 2019) with an alternative policy approach requiring hospitals to engage nurse staffing committees in the determination of appropriate staffing levels. 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. 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. During disaster situations, nurses often find themselves dealing with the challenges of potentially undesirable outcomes of providing care in compromised environments with lack of staff or supplies. Historical Information. 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. RN TO FNP TRANSITION | The First 6 Months. 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. Notify me of follow-up comments by email. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. Texas nurse staffing trends before and after mandated nurse staffing committees. 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. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. I am not qualified to care for these patients because I dont have the knowledge or the experience. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. Brief explanation of why invoking Safe Harbor (It may be helpful to review rules 217.11 and 217.12): Signature(s) of Nurse(s) Invoking Safe Harbor: This website also contains material copyrighted by 3rd parties. 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. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. 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. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? Short title. Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. 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. Nurse staffing, burnout, and health careassociated infection. 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? These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. Legislative update: TNA protects nurses in 84th session. Small, H. (2017). Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. 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. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. Give a copy to your leader and keep a copy for yourself. 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. 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. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). This is often related to the ethical concerns arising from conflicting values and obligations inherent in the disaster work environment. How has Covid amplified issues to your culture? Please enter a Recipient Address and/or check the Send me a copy checkbox. You have a duty to protect the patients and the general public. The National Database of Nursing Quality IndicatorsTM (NDNQI). Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Zolnierek, C. (2019). Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. 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. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. The nurse may supply supporting documents at a later time; however, the comprehensive details . (2007). 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. The Safe Harbor Rule (SHPR) is a nursing peer review process that any type of nurse (licensed vocational nurse or registered nurse) can initiate in good faith whenever asked to take part in assignments or conduct that might result in one or more violations of Texas Board of Nursing rules and statutes. We conclude by considering the common thread among these exemplars. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. As gaps in protection are identified, nurses work to address them through policy change. This provision is called Safe Harbor. To err is human: Building a safer health system. I got some help. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). Willmann, J. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. 394, 1999). Protections are imperfect, but that does not diminish their importance. Texas House Bill No. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. These efforts culminated in the development of the National Database of Nursing Quality Indicators (NDNQI). Nursing education programs first evolved outside of the general education system through hospital-based education for service models. Texas Senate Bill No. Texas Nursing, 89(3), 7-9, 17. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. In the fall of 2007, the Centers for Medicare and Medicaid Services (CMS) announced that it would no longer reimburse hospitals for nursing-related, preventable complications occurring during a patient hospital stay (The George Washington University, 2007). Nelson, A., & Baptiste, A. S. (2006). Thank you! Neither are nurses legal, professional, and ethical duties. 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. 2022 American Nurses Association. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. Nurse(s) Name(s) invoking Safe Harbor: 2. legislators had difficulty appreciating the reality of violence in healthcare settings.The compelling study results were published in 2016 (Texas Department of State Health Services, 2016) and the data supported efforts to pass legislation (HB 280) that funded grants for innovative approaches to reduce workplace violence in health care organizations. The American Nurses Association ([ANA], n.d., para. Nurses are warm, compassionate and forgiving to a fault. Texas Nursing Voice, 7(3): 1, 3-4. This example represents a missed opportunity for nurses to change practice through policy. Thank you for this article. 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. History: . 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. It is offered only as information about nursing topics of interest. 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. Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). London: MacMillan and Company. Nurses can find themselves in all kinds or risky or potentially dangerous situations. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. (1997). She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. Safe Harbor Nursing Peer Review (Texas Occupations Code 303.005, 2019) protects nurses who believe in good faith that they are being requested to engage in conduct that would violate a nurses duty to patient as defined in the board of nursing rules on standards of professional practice and unprofessional conduct. We conclude by considering implications for nursing organizations and nurses among these exemplars. You not only have all 6 step-down patients, you are now charge over the other 18 beds. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. State facts, include the date and time, and why you are refusing or objecting. Intended to improve the safety from physical injuries of both nurses and patients, SB 1525 was signed into law and took effect January 1, 2006. Initially, outcomes data related to nurse staffing was sparse. Nurses have an ethical imperative to engage in policy. 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. Notes on Nursing (1969 ed.). Kudzma, E. C. (2006). I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. Why nurses need whistleblower protection. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. 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. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. Every nurse should be aware of the statutes and rules governing their profession. (2019). After the hard work is finished and the policy becomes how we practice, the origin stories are lost, and progress is often taken for granted. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. Where creative models of care to reduce costs dominated dialogue around nurse staffing in the 1990s, attention was cued to staffing outcomes following the IOM report. She received a BSN from University of Detroit Mercy, magna cum laude, an MSN in adult psychiatric-mental health nursing from Wayne State University, and a PhD in nursing from University of Texas at Austin where she was recognized as the outstanding doctoral student. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy by addressing systemic barriers to optimal patient care and healthy environments through establishment of standards, regulations, and policy. Click the topic below to receive emails when new articles are available. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. Then radiology is taking care of the patient FOR A SHORT TIME. 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! , while specific concerns have evolved and been clarified affects the professional obligation to raise concerns regarding any assignment! 6 Months culminated in the disaster work environment of slips of falls general education system through hospital-based education for models... 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