Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. (2019). She received an ASN from Angelo State University, a BSN and MSN from Queens University of Charlotte where she was recognized as the outstanding graduate student, and a PhD in nursing from University of Texas at Austin. Cates, A. Please confirm that you would like to log out of Medscape. 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). In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). 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. The relationship of nursing workforce characteristics to patient outcomes. I appreciate the legal advice. 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. They are at the service of the patient and the doctor or another medical supervisor. 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. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. or local laws, rules or regulations affecting the nurse's current area of nursing practice. Safe patient handling U.S. enacted legislation snapshot. 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. Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. The facility must have a process by which to further assess the situation. 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. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. London: MacMillan and Company. 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. New Mexico's law was inspired by a Texas law. This includes protections for whistleblowers. As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. 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). (2011). For the first time, patient outcomes could be specifically mapped to nursing care Nurse staffing is resource intensive and is the largest component of hospital operational budgets. 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.. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Good luck! 1, Manuscript 2. 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. Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). For example, a primary care physician and a specialist to whom the . If you log out, you will be required to enter your username and password the next time you visit. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. They participate in operationalizing and implementing emergency preparedness plans within their organizations, they work additional hours, they volunteer at shelters for displaced medically fragile persons, and they coordinate medical supplies, blood donations and other vital resources. Nightingale, F. (1860). 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). 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, . Black (2011) described what, at the time, was thought to be the largest documented patient nosocomial bloodborne pathogen exposure due to inappropriate reuse of equipment and syringes intended for single use. How nurses advocated for their profession in the 86th legislative session. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. 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 make a determination about the situation within 14 days. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. a.cpBtn:hover {background:#666;} (2004). Examples: due to staffing and/or acuity of the patient(s). Orthopedic Nursing, 25(6), 366-379. (2016). I had the next two days off; I interviewed at another hospital where I was immediately hired. The Figure offers additional information about Texas patient advocacy and whistleblower protections. 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. Its a wrap! (2007). Kane. Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. 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. I have worked NICU for 31 years. What do you do? The nursing supervisor calls and tells you to go to the oncology unit youve been floated. Safe patient handling and mobility. 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. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). 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. Commenting is limited to medical professionals. 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. Initially, outcomes data related to nurse staffing was sparse. Nurses are not always in control of the care they provide, so its important that everyone understands the terms of safe harbor and when it may be invoked. B. Put your objections or refusal in writing. 16, New York companion bills A11484, A07836, S05116, and S08358. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. working mandatory overtime, accepting expanded patient assignments, etc. 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. Nurses who accept or make assignments must consider patient safety. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. 192: Section 301.413(b-1). Decide on what kind of signature to create. We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. 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! 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. 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). She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. 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. Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. 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. 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. 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? Journal of Nursing Regulation, 3(3), 19-23. https://doi.org/10.1016/S2155-8256(15)30203-9, Unruh, L. (2008). 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. Nurses are often called to respond to disasters. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. 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. 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? 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. 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. RN TO FNP TRANSITION | The First 6 Months. (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 . American Journal of Infection Control, 40(6), 486-490. https://doi.org/10.1016/j.ajic.2012.02.029, Coffman, J., Seago, J. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. Silver Springs, MD: American Nurses Association. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. Establishing a foundation for the role of nurses in evidence-based advocacy, she emphasized the progressive nature of nursing, urging: Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? (Nightingale, 1860, p. 40-41). 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. (2015). Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. You will receive email when new content is published. See Table for examples of these laws. 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. My question is this. Consider another situation: You are an experienced nurse. Policy Politics & Nursing Practice 9(4), 274287. 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. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. Ask for help and help your colleagues when they are facing an unsafe assignment. Nurses who accept or make assignments must consider patient safety. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. 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). We discuss this in the context of practice in the state of Texas. doi: 10.1177/1527154408319287. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 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. A medical director or member of the medical staff must determine whether the order was reasonable. Figure. If the nurse files Safe Harbor and the reason is to prevent unsafe care for patients' then the nurse should theoretically be safe from retaliation, but if the nurse is only protecting themselves or their license then the BON will offer little protection from consequences at their facility. Often policy change involves an incremental approach that requires persistence. for Nursing Education. (2019). 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. (1999). Online Journal of Issues in Nursing, 9(3). Any request for safe harbor, be it on this form or The Texas law applies to employers of eight or more nurses. What are the nurse's options here? Good luck! Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. Nurse(s) Name(s) invoking Safe Harbor: 2. 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). You've successfully added to your alerts. 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. We are looking for someone to be able to work closely with our business end . The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. Your license is not a free pass for employers to use you anywhere they feel a need. 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. 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. A joint investigation by federal and state agencies revealed violation of standard infection control practices. The nurse may supply supporting documents at a later time; however, the comprehensive details . As gaps in protection are identified, nurses work to address them through policy change.As gaps in protection are identified, nurses work to address them through policy change. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. The American Nurses Association ([ANA], n.d., para. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . However, changing practice through policy does not stop with the NPA. They are not providing any cross training at all. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. The unit also has 18 general medical beds. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. The facility may not retaliate against the nurse who invokes the safe harbor. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Safe Harbor for Nurses . (2002). 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. 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. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). Nurse practice acts guide and govern nursing practice. (2019, January 30). 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. 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. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. 5 pages, 2066 words A place where registered nurses and nurse practitioners offer helpful videos and articles and advice to other nurses. She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Background: # 666 ; } ( 2004 ), 19 ( 1 ), 366-379 and standing contributes fatigue! Form: Select the document you want to sign and click Upload (. Here to provide perspective related to nurse staffing was sparse where I was immediately.! 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