The law applies to entities having three or more nurses that are licensed by the department of health to provide healthcare on their premises. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. These challenging situations can cause mental and physical fatigue leading to moral distress. Kohn, L. T., Corrigan, J., & Donaldson, M. S. Texas Senate Bill No. 2410, 2019), which allows nurses to invoke safe harbor orally in situations where patient needs prevents nurses from leaving the beside to complete safe harbor forms. (2009). Initially, outcomes data related to nurse staffing was sparse.Measurements of quality shifted away from an interest in structure and process, and instead targeted outcomes: patient, staff, and financial. Initially, outcomes data related to nurse staffing was sparse. I got some help. 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. 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. 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. 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. Dont use subjective or accusatory terms such as short-staffing. Sign it. Washington, DC: American Nurses Publishing. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. 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). 192: Section 301.413(b-1). What else can we do to ensure their care and their safety?. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. Texas Nursing, 89(3), 7-9, 17. (2002). (1997). Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. 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. 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? A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. 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. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. 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. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. 16, New York companion bills A11484, A07836, S05116, and S08358. (2015). working mandatory overtime, accepting expanded patient assignments, etc. Are you unqualified to care for the patients assigned? Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. 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 strongly recommend contacting your state board of nursing, state nurses association, and the state facility licensing board to find out what their regulations are. 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. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. You submit it to the BON. Put your objections or refusal in writing. I am so sorry you are going through this. (2016). 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. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. 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). Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. JOIN TNA AND ANA TODAY, 3/1/2023TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, 3/28/2023TPAPN Peer Support Partner Information Session, 3/31/2023Nuts & Bolts of Peer Review Workshop, 4/18/2023TPAPN Peer Support Partner Information Session, Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759, 800.862.2022 | 512.452.0645 | tna@texasnurses.org, Association Management Software Powered by, TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, TPAPN Peer Support Partner Information Session. Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. 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. London: MacMillan and Company. Cite this: A 'Safe Harbor' for Unsafe Nursing Assignments-Medscape-Apr26,2019. 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. Your license is not a free pass for employers to use you anywhere they feel a need. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. 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. 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. New Mexico's law was inspired by a Texas law. Texas Nursing Voice, 5(3):1, 4. The Texas law applies to employers of eight or more nurses. The shortage of qualified practicing nurses is not new. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. In 2020, the Year of the Nurse and Midwife, let every nurse and professional nursing organization continue the forward progress that advocacy supports. Retrieved from https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, Texas Legislature Online. (2015). Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. Licensure eligibility criteria and the first licensure exam were developed in 1904. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. Consider another situation: You are an experienced nurse. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. For example, the Texas State Board of Pharmacy (TSBP) . Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. 61-3A-1. 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! and keep a record of everything. Beth J. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. 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. Thank you for this article. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. Name of person/supervisor (and title) making assignment or requesting the conduct: 5. We conclude by considering the common thread among these exemplars. 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. 6, ANA, 2009). I appreciate the legal advice. Monthly Labor Review. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. Examples: due to staffing and/or acuity of the patient(s). Ask for help and help your colleagues when they are facing an unsafe assignment. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Short title. 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. For the first time, patient outcomes could be specifically mapped to nursing careBecause the NDNQI provided unit level data, it enabled comparisons across like units and like hospitals. legislators had difficulty appreciating the reality of violence in healthcare settings. Occupational injuries and illnesses among registered nurses. I reference the ANA Code often with my students! The federal level (CMS) requires certain staffing too. Share cases and questions with Physicians on Medscape Consult. 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. 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. The nursing office says it has no one to help you for at least another 4 hours, if that. Invoking safe harbor shouldn't change anything. When considering how to proceed in a difficult legal, ethical and professional situation, solid advice grounded in the law, which is backed by the American Nurses Association, is the best way to proceed. The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. 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