safe harbor nursing examples

We are looking for someone to be able to work closely with our business end . Texas Nurses Association. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. This article is not legal advice. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. 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. 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. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. Consider another situation: You are an experienced nurse. Nelson, A., & Baptiste, A. S. (2006). Contrary to what the supervisor said, you have most of the sickest patients on the unit and it is a regular patient care assignment, including administration of chemotherapy for which you are not qualified. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. 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. The ICU wants to give you a new patient and things are going from bad to worse. 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 . Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). The unit also has 18 general medical beds. Thank you for your comment. Nursing peer review conducted by any entity must comply with NPR Law and with applicable Board rules related to incident-based or safe harbor nursing peer review. Texas Nursing Voice, 5(3):1, 4. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. (2003). 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. Policy, Politics & Nursing Practice, 16(3-4), 79-96. doi.org/10.1177/1527154415616254. 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. (North Carolina Board of Nursing, 2019). Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . 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. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. Then radiology is taking care of the patient FOR A SHORT TIME. 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. 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. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). 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. 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. Workplace violence study. Both professional nursing organizations, and individual nurses, must continue advocacy at all levels. A nurse must invoke safe harbor before engaging the act in question. This is retaliation and it is barred by law and professional practice rules. Further protections (Texas Occupations Code, 2019) include refusal to engage in reportable conduct; reporting staffing concerns in hospitals; nurses who refuse to engage in conduct reportable to the board of nursing; and nurse reporting of concerns within a facility about patient exposure to substantial risk of harm or failure to conform to minimum professional, regulatory, or accreditation standards. 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. Most state/territorial nursing associations and state boards of nursing echo these statements and many states have statutes that protect nurses who point out unsafe conditions. The risks are not only damaging to the health of nurses and patients, but also are costly in terms workers compensation insurance and nurse turnover. This accountability came in the form of changes in payment policy. Nurse practice acts guide and govern nursing practice. Safe patient handling and mobility. Cates, A. Responding to a disaster is a familiar process for several nurses in Texas. 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, . 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. Recognizing this gap in protection, TNA worked with Representative Stephanie Klick, RN, one of two nurses in the Texas Legislature, to pass House Bill 2410 Oral Safe Harbor (Texas House Bill No. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. 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. 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. How nurses advocated for their profession in the 86th legislative session. Any request for safe harbor, be it on this form or She retired from the U.S. Army in 2015 as a Lieutenant Colonel. Dont use subjective or accusatory terms such as short-staffing. Sign it. The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. You cannot be responsible for patients in 2 different locations (units, departments) at the same time UNLESS a qualified provider is covering the other patient. 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: Effects of hospital care environment on patient mortality and nurse outcomes. American Nurses Association. If you are a leader, do not punish the nurse objecting or refusing the assignment. 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. Journal of Nursing Administration, 42(10), Supplement: S10S16. 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. 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. Texas Nursing Voice, 7(3): 1, 3-4. 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. As gaps in protection are identified, nurses work to address them through policy change. Nurse staffing, burnout, and health careassociated infection. Required fields are marked *. Often policy change involves an incremental approach that requires persistence. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. 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. 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. 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. 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American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. Policy Politics & Nursing Practice 9(4), 274287. 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. CORONAVIRUS HOTLINE 855.487.7221. deconservices@cleanharbors.com. This database includes measures directly related to nursing care and patient outcomes (Montalvo, 2007) such as: nursing hours per patient days; hospital-acquired infections and pressure ulcers; and skill mix (percent of total nursing hours supplied by different types of direct care providers). Its a wrap! Given the outcome and scope of the outcomes of successful advocacy, and the failure to advocate discussed above, it is important to address the need for advocacy protections. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. 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. 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. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. 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. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. The nurse may supply supporting documents at a later time; however, the comprehensive details . 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. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. American Nurses Association. 1, Manuscript 2. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. 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