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 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. Nurse executives should support nurses who exercise their rights to protect their licenses and not view safe harbor requests as an affront to their leadership. 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. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. (2012). Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). What do you do? This assistance is covered by the SHQ (90%) and the City of Montral . Short title. 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. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. Click the topic below to receive emails when new articles are available. However, there is a large majority who have never experienced working in disaster situations such as hurricanes, mass shootings, or disease outbreaks and therefore may not be aware of their role in the emergency preparedness process and what they can do for themselves. Thank you! You must declare any conflicts of interest related to your comments and responses. A brief history of Florence Nightingale and her real legacy, a revolution in public health. (1999). 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.. They are at the service of the patient and the doctor or another medical supervisor. (2004). This protects them from facing punitive measures from their employer, losing their nursing license or being sued in court for putting a patients life in danger. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. for Nursing Education. 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. That is something you need to address with your risk manager AND absolutely worth a phone call to your state board of nursing for their guidance. 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. Texas Senate Bill No. 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. A medical director or member of the medical staff must determine whether the order was reasonable. Legal expert Martin Chitwood weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. Thank you for this article. 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! 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). 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. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). Nurses who accept or make assignments must consider patient safety. 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). Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. 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). The federal level (CMS) requires certain staffing too. 1, Manuscript 2. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. 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. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. Initially, outcomes data related to nurse staffing was sparse. 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). Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. History: . As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. 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. NurseGuidance.com is a place where nurses offer helpful videos and articles with advice to other nurses. 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). We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. 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. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. The nurse may accept the assignment and be protected from retaliation from the employer and disciplinary action from the board of nursing pending the committee's decision. 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. a Supervisor in Kindred Hospital in West Minister California has a Habit of assigning RN to a patient in 2 different departments, So when a call light is on 1 patient , you cannot see or hear your other patient, And if refuse this assignment , you are reprimanded by your superiors, The CNA rep also has no idea to battle this on going problem. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. 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). The Texas process has been criticized as cumbersome in emergency situations. However, changing practice through policy does not stop with the NPA. A nurse must invoke safe harbor before engaging the act in question. 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. Historical Information. 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. I reference the ANA Code often with my students! Thank you for your comment. What else can we do to ensure their care and their safety?. 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. Code of ethics with interpretive statements. Nurse staffing is resource intensive and is the largest component of hospital operational budgets.The complexity of nursing characteristics (e.g., skill mix); patient characteristics (e.g., acuity and case mix); and the interaction of these variables within the hospital environment make it extremely difficult to define a template as simple as a nurse-to-patient ratio to ensure appropriate staffing (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007; Unruh, 2008). She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. The Texas law applies to employers of eight or more nurses. The unit also has 18 general medical beds. 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. 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. Workplace violence. Insurance companies pay the price for HAIs. Safe patient handling U.S. enacted legislation snapshot. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. Table. And nurses need to be ready for a high-stress environment that lasts not just a few days, but potentially for many months. See Table for examples of these laws. 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. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). This includes protections for whistleblowers. I hope youll never need it but under current circumstances, you may. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. 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). Small, H. (2017). The hospital broke the law when it retaliated against the nurses for making an external report. Often policy change involves an incremental approach that requires persistence. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. How nurses advocated for their profession in the 86th legislative session. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 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. I agree! Orthopedic Nursing, 25(6), 366-379. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Or go, try, risk making a mistake, and hope for the best? Nurse staffing advocacy. Is the assignment outside the scope of your practice or your experience and knowledge level? This provision is called Safe Harbor. Initially, outcomes data related to nurse staffing was sparse. 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. Montalvo, I. Nurse practice acts guide and govern nursing practice. (2007). Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. 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. 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. State facts, include the date and time, and why you are refusing or objecting. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. I had the next two days off; I interviewed at another hospital where I was immediately hired. Because she was in the middle of a procedure, she could not leave the patients bedside to invoke safe harbor in writing as required by existing law. 192, 2011). 394, 1999). New Mexico's law was inspired by a Texas law. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. 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. please help the nurses reason legally to this unsafe patient services. Centers for Disease Control and Prevention (2013). Dont use subjective or accusatory terms such as short-staffing. Sign it. 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? Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. 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. This article is not legal advice. Please confirm that you would like to log out of Medscape. 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 . Any request for safe harbor, be it on this form or Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policyAlthough Ms. Nightingale was often successful in single-handedly influencing policy through her relationships with military and hospital leaders, most policy work involves collaboration among nurses and other stakeholders. World Health Organization. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). 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. You've successfully added to your alerts. I appreciate the legal advice. You have a duty to protect the patients and the general public. A nurse may not feel as if they have the option of saying no or refusing to engage in these kinds of situations, so invoking safe harbor may be their only choice. Revision of the code in 1995 expanded it to include social ethics, global concerns, and emphasis on the important role of nurses in health policy. How has Covid amplified issues to your culture? I am not qualified to care for these patients because I dont have the knowledge or the experience. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. Remember that it could be you or a loved one in the patient room someday. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. (2007). 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. Journal of Nursing Administration, 38(5): 223229. Nurses have an ethical imperative to engage in policy. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. I am so sorry you are going through this. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. 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. Create your signature and click Ok. Press Done. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. 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. Why nurses need whistleblower protection. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. Examples: due to staffing and/or acuity of the patient(s). You submit it to the BON. 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. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. Ask for help and help your colleagues when they are facing an unsafe assignment. 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. (n.d.). Silver Springs, MD: American Nurses Association. We conclude by considering implications for nursing organizations and nurses among these exemplars. Give a copy to your leader and keep a copy for yourself. 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. Solving tough problems through innovation and proven methodology. Consider another situation: You are an experienced nurse. Nelson, A., & Baptiste, A. S. (2006). Licensure eligibility criteria and the first licensure exam were developed in 1904. 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. Safe patient handling and mobility. In 2019, legislation supported by NLAC as well as the Texas Hospital Association was proposed to establish Violence Prevention Committees within healthcare organizations (HB 2980); the effort failed (Zolnierek, 2019). (North Carolina Board of Nursing, 2019). Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. No nurse, from a patient safety and legal liability standpoint, should ever be assigned primary care responsibility for patients that they are unqualified to care for yes, your license says you MAY care for these patients BUT that is only AFTER youve had training and supervision. At another hospital where i was immediately hired loved one in the 86th legislative session must invoke harbor... & Wu, E. S. ( 2012 ) follow the step-by-step instructions below receive! Order was reasonable advantage of the medical staff must determine whether the order was reasonable to staffing acuity! And nursing organizations and nurses among these exemplars 2006 ) University of.... Safety through a nursing Peer Review committee ( NPRC ) interest related to nurse staffing was sparse from positions... Against the nurses in this situation practice through policy does not stop with the supervisor 's law inspired... How nurses can use it to protect themselves in risky situations ( SH:. All material on this website is protected by copyright, copyright 1994-2023 by WebMD LLC going this... Unsafe patient services legal expert Martin Chitwood weighs in about nursing safe safe harbor nursing examples remember it... 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