Evidence-based practices for safe patient handling and movement. Texas Senate Bill No. (2016). Policy Politics & Nursing Practice 9(4), 274287. Examples of State Legislation to Improve Safe Handling, Hawaii House Concurrent Resolution No. Workplace violence. 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. You will receive email when new content is published. Twenty two nurses were investigated by the Nevada State Board of Nursing for alleged violations of the Nevada Nursing Practice Act, notably failure to safeguard patients (Black, 2011). Washington, DC: American Nurses Publishing. This was the latest of many staffing incidents at this facility. 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. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Protections are imperfect, but that does not diminish their importance. Nightingales post-war work on hospital reform is among her most lasting accomplishments (Small, 2017). This provision is called Safe Harbor. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. 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. As gaps in protection are identified, nurses work to address them through policy change. Our hospital is expected to staff this unit. (2002). It is Christmas Eve and you report to your unit to work the night shift. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. 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. She retired from the U.S. Army in 2015 as a Lieutenant Colonel. New York, NY: Dover Publications. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. Texas was the first state to have safe patient handling and movement policies enacted in legislation. If you were an internal medicine physician and told that you, as the only doctor available, had to perform a craniotomy, would you do it? The unit also has 18 general medical beds. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. The ICU wants to give you a new patient and things are going from bad to worse. 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. 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. The ANA position statement is an excellent resource to start. Its a wrap! Nurses are often called to respond to disasters. London: MacMillan and Company. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. Dont use subjective or accusatory terms such as short-staffing. Sign it. What do you do? Nurse(s) Name(s) invoking Safe Harbor: 2. (BJ) Strickland is from Tennessee. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Safe Harbor Forms - Nursing Peer Review. Nightingale, F. (1914). Zolnierek, C. (2019). 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. 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. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. This accountability came in the form of changes in payment policy. New York, NY: Little, Brown Book Group. Imagine this scenario: A nurse who has worked for 2 years in an adult medical-surgical unit reports for work and learns that she is assigned to work in neonatal intensive care that day. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. Texas nurse staffing trends before and after mandated nurse staffing committees. While many nurses recognized the reuse practice as inconsistent with safe infection control practices, complacency among coworkers and fear of retaliation inhibited reporting of concerns. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. 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. 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? 24-Hour. Recently our hospital has opened an adult unit as an overflow from the University hospital. (2019). Objections must be in writing so check to see if your facility or state has a form and keep several blank copies in your locker or backpack. Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. This is such an unsafe situation for everyone. We expect the successful candidate to be able to configure and customize Microsoft Dynamics 365 CRM applications using a variety of technologies. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Board of nursing rules outline the procedures nurses must follow to access these protections. Thank you for your comment. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. A medical director or member of the medical staff must determine whether the order was reasonable. Notify me of follow-up comments by email. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. Or go, try, risk making a mistake, and hope for the best? Under the Safe Harbor for Nurses act, a nurse is protected from adverse action by a facility when the nurse makes a good faith request to be allowed to reject an assignment. (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 . Although both bills failed to pass in 2011 (Willmann, 2011), similar legislation enhancing penalties for assault of emergency department personnel passed in the next legislative session (Willmann, 2013). 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. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. I am so sorry you are going through this. Is the assignment outside the scope of your practice or your experience and knowledge level? 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. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). What else can we do to ensure their care and their safety?. 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). Nurse staffing and patient, nurse, and financial outcomes. 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. Commenting is limited to medical professionals. 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). 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 new law in New Mexico gives nurses another option. 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. 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, . 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. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. Give a copy to your leader and keep a copy for yourself. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. 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). 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? Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. What if the patient or supervisor asks a nurse 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? NPAs have not remained stagnant over the past century, rather they have evolved but only with the active involvement of nurses in legislative efforts to change statute and update policies related to nursing practice. 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). 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. Orthopedic Nursing, 25(6), 366-379. 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. Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. 2011 Session: A roller coaster ride for nursing. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. I have worked NICU for 31 years. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. 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. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. These challenging situations can cause mental and physical fatigue leading to moral distress. Insurance companies pay the price for HAIs. 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. American Nurses Association. A nurse must invoke safe harbor before engaging the act in question. Texas was the first state to have safe patient handling and movement policies enacted in legislation. 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. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. 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. 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. Nurse StaffingStaffing involves a process of matching and providing staff resources to patient care needs. How has Covid amplified issues to your culture? Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. 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