The relationship of nursing workforce characteristics to patient outcomes. Online Journal of Issues in Nursing, 12(3). Nurse staffing is resource intensive and is the largest component of hospital operational budgets. Nurses are often called to respond to disasters. Required fields are marked *. (2007). I work at a Childrens and Womens hospital. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. 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. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Nursing enjoys successful session: 2013 legislative session from a nursing perspective. (2009). Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. If you are a leader, do not punish the nurse objecting or refusing the assignment. Notes on Nursing (1969 ed.). 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. Your email address will not be published. She has practiced law in state and federal courts in Tennessee since 1996 with an interest in healthcare risk management, employment law and medical malpractice. In 2019, legislation supported by NLAC as well as the Texas Hospital Association was proposed to establish Violence Prevention Committees within healthcare organizations (HB 2980); the effort failed (Zolnierek, 2019). Handle with care: The American Nurses Associations campaign to address work-related musculoskeletal disorders. Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. Discussions of nurse staffing followed these trends. 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. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. This is such an unsafe situation for everyone. Executive Board designates 2020 as the Year of the Nurse and Midwife. Retrieved from https://www.who.int/hrh/news/2019/2020year-of-nurses/en. 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. (2019, January 30). (2013). In addition, rising obesity rates means that nurses are caring for patients who are heavier and have a higher rate of comorbid conditions. 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. 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. Healthcare attorneyDisclosure: Carolyn Buppert, MSN, JD, has disclosed no relevant financial relationships. For example, the Texas State Board of Pharmacy (TSBP) . This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. 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! 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. Nursing education programs first evolved outside of the general education system through hospital-based education for service models. A., & Spetz, J. 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;} 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. For example, dissatisfied with the staffing by patient acuity model legislated in the early 1990s, (Coffman, Seago, Spetz, 2002) members of the California Nurses Association successfully pressed 164 legislators to pass a prescriptive bill specifying the maximum number of patients to be assigned to a registered nurse in each patient care area (California Assembly Bill No. Everywhere industry meets environment, Clean Harbors is on-site, providing premier environmental and industrial services. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. 2022 American Nurses Association. 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. 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. Nurse leaders should take note of Provision 6: acquiescing and accepting unsafe or inappropriate practices, even if the individual does not participate in the specific practice, is equivalent to condoning unsafe practice.. Florence Nightingale to her nurses: A selection from Miss Nightingales addresses to probationers and nurses of the Nightingale School at St. Thomas Hospital. Follow the step-by-step instructions below to design your safe harbor request form: Select the document you want to sign and click Upload. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Centers for Disease Control and Prevention (2013). 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. I had the next two days off; I interviewed at another hospital where I was immediately hired. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). (Eds.). This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). 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). Figure. Date/Time of Request: 3. You tell the supervisor youve never worked oncology. The nurse who invokes safe harbor may not leave the work setting without collaborating with the supervisor. If a patient, supervisor or doctor asks the nurse to violate one of these rules, the nurse can invoke safe harbor before committing the act to ensure that they arent held legally responsible for what happens next. You've successfully added to your alerts. New York, NY: Dover Publications. Examples: due to staffing and/or acuity of the patient(s). The unit also has 18 general medical beds. Non-reimbursable conditions include hospital-acquired pressure ulcers and readmissions. 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. 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). This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. Nurses can find themselves in all kinds or risky or potentially dangerous situations. Cates, A. Good luck! Initially, outcomes data related to nurse staffing was sparse. 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. For example, a primary care physician and a specialist to whom the . for Nursing Education. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. As gaps in protection are identified, nurses work to address them through policy change. Safe Harbor (SH): A process that protects a nurse from employer retaliation, suspension, termination, discipline, . Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent.In sum, the need for evaluation of policies is vital. Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. 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. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. These challenging situations can cause mental and physical fatigue leading to moral distress. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. This law requires hospitals and nursing homes to adopt policies and procedures for the safe handling of patients that control the risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. (Texas Senate Bill 1525, 2005). 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. Commenting is limited to medical professionals. The history of the American Nurses Association. North Carolina Board of Nursing. 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. Are you unqualified to care for the patients assigned? Code of ethics with interpretive statements. Policy Politics & Nursing Practice 9(4), 274287. 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. To ensure policies are effective, the impact on nursing practice must be evaluated to make certain policies are having the desired effect and have not created unintended consequences. Retrieved from https://www.nursingworld.org/ana/about-ana/history/. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. 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. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. 394. Legislative update: TNA protects nurses in 84th session. 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. Over the years, the core values of nursing have remained constant and principles upheld, while specific concerns have evolved and been clarified. A nurse must invoke safe harbor before engaging the act in question. 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. The federal level (CMS) requires certain staffing too. Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. 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. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. This article is not legal advice. 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. The Texas process has been criticized as cumbersome in emergency situations. Nurse participation in health policy was recognized with the inclusion of the nurse-as-advocate role, added in 1976. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. It is offered only as information about nursing topics of interest. New Mexico's law was inspired by a Texas law. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. The Texas Nursing Practice Actincludes several advocacy protections for 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. The American Nurses Association ([ANA], n.d., para. Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). 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 . (2016). The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. Insurance companies pay the price for HAIs. 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. Texas Senate Bill No. Choose My Signature. How nurses advocated for their profession in the 86th legislative session. World Health Organization. Texas Senate Bill No. A joint investigation by federal and state agencies revealed violation of standard infection control practices. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. The ANA position statement is an excellent resource to start. Effects of hospital care environment on patient mortality and nurse outcomes. Time now is 10:30 and you just begin your med pass. I got some help. 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. 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. Nightingale, F. (1860). 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. Silver Springs, MD: American Nurses Association. Is the assignment outside the scope of your practice or your experience and knowledge level? 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. 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. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. Click the topic below to receive emails when new articles are available. With the increasing body of evidence documenting the relationship between nurse staffing and patient outcomes, several states have passed legislation requiring organizations to adopt more specific policies and practices. As gaps in protection are identified, nurses work to address them through policy change. 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. 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. 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. Why nurses need whistleblower protection. or local laws, rules or regulations affecting the nurse's current area of nursing practice. (Read the story of how one nurse worked through TNA to make this possible.). Frequent bending and standing contributes to fatigue and may increase the risk of slips of falls. 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. doi: 10.1097/01.NNA.0000312773.42352.d7, American Nurses Association. and keep a record of everything. Location of requested conduct/assignment: 4. The nursing office says it has no one to help you for at least another 4 hours, if that. To staffing and/or acuity of the patient ( s ) be eroded through subsequent legislation agency. 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