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. The hospital broke the law when it retaliated against the nurses for making an external report. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Nightingale, F. (1914). Please see our, You are being redirected to Medscape Education, Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: HPV Is Probably Not at the Top of Our List. Nurse practice acts guide and govern nursing practice. Please confirm that you would like to log out of Medscape. Health Affairs, 21(5), 53-64. doi: 10.1377/hlthaff.21.5.53, de Castro, A. During the most recent legislative session, TNA leaders negotiated bill language with the Texas Hospital Association that would have required workplace violence prevention plans with input from direct care nurses. 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. A nurse may invoke safe harbor to err on the side of caution whenever they feel that their actions as requested by a patient or supervisor may violate Board Statures and Rules. The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. 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. 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. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). You not only have all 6 step-down patients, you are now charge over the other 18 beds. Thank you for this article. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? 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. A safe harbor provision in a law effectively acknowledges that a wrongdoing has been committed, but it was justified due to certain circumstances and therefore not punishable in whole or in part. 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. Establishing a foundation for the role of nurses in evidence-based advocacy, she emphasized the progressive nature of nursing, urging: Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? (Nightingale, 1860, p. 40-41). Nurses and other front-line health care works will be the most vulnerable populations to the virus. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. It is one thing to have patients on a unit and one goes to radiology. This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. The ANA position statement is an excellent resource to start. Your email address will not be published. The nurse and supervisor document the date, time, location, and reason for the invocation of safe harbor. I agree! 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. Successful advocacy requires the identification of concerns by individual nurses, coupled with leadership and persistence of nursing organizations with strength in numbers and a policy agenda. Nurses who accept or make assignments must consider patient safety. 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. The nursing office says it has no one to help you for at least another 4 hours, if that. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. please help the nurses reason legally to this unsafe patient services. When a potential situation arises either at the beginning of the shift or later on if conditions deteriorate try to identify exactly what the problem is. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. Table. What else can we do to ensure their care and their safety?. Input from nurses is the foundation of this advocacy work to identify the need for policy change and make the case for why change is needed. Texas was the first state to have safe patient handling and movement policies enacted in legislation. We then 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. 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. B. RN TO FNP TRANSITION | The First 6 Months. In the mid- to late-1990s, the American Nurses Association (ANA) led nursing efforts to identify measures that would link availability of nursing services to quality (ANA, 1997; Montalvo, 2007). Nightingale, F. (1860). 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 . Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. Adequate coverage runs about $10-12/month and many policies include a legal representation benefit if your BON tries to discipline you. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. You've successfully added to your alerts. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. (2003). A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. 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). You submit it to the BON. Other states have passed legislation (ANA, 2019) with an alternative policy approach requiring hospitals to engage nurse staffing committees in the determination of appropriate staffing levels. 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). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Every nurse should be aware of the statutes and rules governing their profession. Many nurses may remember the times before cars had seatbelts and smoking in the nurses lounge was a common practice. Kudzma, E. C. (2006). How has Covid amplified issues to your culture? As gaps in protection are identified, nurses work to address them through policy change. 394. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. 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. Monthly Labor Review. (2016). Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). 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. 192, 2011). 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. Our content creators range from New Grad Nurses to Experienced Registered Nurses and Nurse Practitioners. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a 1 nurse to 3 patients ratio. Even if you have never been in questionable situation, you should know your organizations policies and your states laws and regulations regarding refusing an assignment. 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. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. 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. Share cases and questions with Physicians on Medscape Consult. 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. 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. 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. I had the next two days off; I interviewed at another hospital where I was immediately hired. 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. I reference the ANA Code often with my students! 6, ANA, 2009). 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. A brief overview is offered here to provide perspective related to the specific exemplars we discuss. I hope youll never need it but under current circumstances, you may. Retrieved from https://www.ncbon.com/board-information-historical-information, Russell, K. A. Small, H. (2017). 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). Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . If you have legal questions, please speak with a licensed attorney in your area. 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. Taylor, J. L. (2010). Often policy change involves an incremental approach that requires persistence. 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. This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. Washington, DC: National Academy Press. 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). Florence Nightingale and healthcare reform. Time now is 10:30 and you just begin your med pass. 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. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? For example, a telemetry unit in one small community hospital can compare its pressure ulcer and vacancy rates to a similar unit in another community hospital. World Health Organization. I work at a Childrens and Womens hospital. (2011). 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. Neither the author or the website publisher are responsible for any actions a reader may take based on material in this article or on this website. Occupational injuries and illnesses among registered nurses. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. 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