(1997). (2007). Board of nursing rules outline the procedures nurses must follow to access these protections. 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. A medical director or member of the medical staff must determine whether the order was reasonable. Our hospital is expected to staff this unit. CORONAVIRUS HOTLINE 855.487.7221. [email protected]. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. Texas Nursing, 89(3), 7-9, 17. 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. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. Nurses have an ethical imperative to engage in policy. Good luck! In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. 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. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. 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. 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. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. 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. 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. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). Every nurse should be aware of the statutes and rules governing their profession. Notify me of follow-up comments by email. A new law in New Mexico gives nurses another option. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. 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 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. One of the first objectives of the new organization was the passage of legislation in 1909 requiring registration of nurses through a Board of Nurse Examiners, creating the first nurse practice act in Texas (Brown, 2010). 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. (2015). 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. (2019). Code of ethics with interpretive statements. As gaps in protection are identified, nurses work to address them through policy change. Notes on Nursing (1969 ed.). Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. They are not providing any cross training at all. 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 . In the meantime, make sure you document what you were told, who told you, what they said verbatim, when, etc. To err is human: Building a safer health system. 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). She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. Its a wrap! It is offered only as information about nursing topics of interest. We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). 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. 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? Ellen Martin, PhD, RN, CPHQ, CPPSEmail: [email protected]. working mandatory overtime, accepting expanded patient assignments, etc. A few years later, nineteen nurses convened on February 22, 1907 to establish the Graduate Nurses Association of Texas, later renamed the Texas Nurses Association (TNA). I am not qualified to care for these patients because I dont have the knowledge or the experience. Legislative update: TNA protects nurses in 84th session. 16, New York companion bills A11484, A07836, S05116, and S08358. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. Thank you for this article. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . American Nurses Association. The history of the American Nurses Association. 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. You submit it to the BON. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . Consider another situation: You are an experienced nurse. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. And now nurses can also use oral safe harbor when they are unable to stop what they are doing to fill out forms. 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. Texas House Bill No. Texas Nursing Voice, 7(3): 1, 3-4. I worked my two weeks notice under the icy glare of my head nurse, knowing Id done the best I could to keep my patients safe. 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. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). There are three variants; a typed, drawn or uploaded signature. 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. I hope youll never need it but under current circumstances, you may. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Nurse staffing, burnout, and health careassociated infection. 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. a.cpBtn { display: inline-block; background: #b61f24; border-radius: 5px; text-align: center; color: #fff; padding: 0 15px; width: 200px; height: 56px; font-size: 13px; position: relative; margin: 0 auto 20px; line-height: 56px;} What do you do? or local laws, rules or regulations affecting the nurse's current area of nursing practice. All rights reserved. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. 1525. NPAs frame nursing practice by defining a professional scope and educational requirements for practice. As for the two examples at the beginning, they happened and I was the nurse. World Health Organization. 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. Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). 6, ANA, 2009). 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. I have worked NICU for 31 years. The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. It is Christmas Eve and you report to your unit to work the night shift. 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