Your email address will not be published. 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. https://www.youtube.com/watch?v=CD7dqj1iPwQ, 10 Questions an Operating Room Registered Nurse Candidate Should Ask the Interviewer. American Nurses Association. Licensure eligibility criteria and the first licensure exam were developed in 1904. Nurse staffing advocacy. She doesn't think she can provide safe care to sick neonates, and says so to the supervisor, who tells her to go to the neonatal unit anyway. Workplace violence. A nurse might be forced to do something that could get them in trouble with their employer or the state board of nursing. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. The unit also has 18 general medical beds. 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). 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? weighs in about nursing safe harbor and how nurses can use it to protect themselves in risky situations. Recognizing this gap in protection, TNA worked with Representative Stephanie Klick, RN, one of two nurses in the Texas Legislature, to pass House Bill 2410 Oral Safe Harbor (Texas House Bill No. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. 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. Kudzma, E. C. (2006). 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. The relationship of nursing workforce characteristics to patient outcomes. Members with any question (not just those relating to practice) can take advantage of the online Member Helpline. 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. Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. 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. New York, NY: Dover Publications. Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. Nurse practice acts guide and govern nursing practice. Musculoskeletal Injury PreventionPatient transfers, lifting, and handling are physically demanding and present clear risk for both the patient and the nurse. The ANA (2015) adopted its first formal code of ethics in 1950 to express the values and ideals for the nursing profession. Safe Harbor for Nurses . Nurses who accept or make assignments must consider patient safety. 1, Manuscript 2. (2007). Discussions of nurse staffing followed these trends. Online Journal of Issues in Nursing, 9(3). 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. Put your objections or refusal in writing. 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. This act [61-3A-1 through 61-3A-3 NMSA 1978] may be cited as the "Safe Harbor for Nurses Act". 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. Examples: due to staffing and/or acuity of the patient(s). My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. (2015). Advocacy in Nursing Regulation: Nurse Practice ActsThe original intent of nurse practice acts was the regulation of nursing practice through registration, now licensure (Russell, 2012). Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. A nurse must invoke safe harbor before engaging the act in question. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. Silver Springs, MD: American Nurses Association. The current position statement, Rights of Registered Nurses When Considering a Patient Assignment, (ANA, 2009) expressly states that nurses have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). 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. legislators had difficulty appreciating the reality of violence in healthcare settings.The compelling study results were published in 2016 (Texas Department of State Health Services, 2016) and the data supported efforts to pass legislation (HB 280) that funded grants for innovative approaches to reduce workplace violence in health care organizations. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . You've successfully added to your alerts. Centers for Disease Control and Prevention (2013). She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. COMPREHENSIVE REQUEST FOR NURSING SAFE HARBOR PEER REVIEW (SHPR) NOTE: ONLY SECTION I (pages 3-6) MUST BE COMPLETED 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. Retrieved from https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, Texas Legislature Online. a.cpBtn:hover {background:#666;} See Table for examples of these laws. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Remember that it could be you or a loved one in the patient room someday. If you log out, you will be required to enter your username and password the next time you visit. Decades of research have confirmed the relationship between nurse staffing and patient outcomes such as mortality (Aiken et al., 2012; Aiken, Clarke, Sloane, Lake, & Cheney, 2008), healthcare-associated infections (Cimiotti, Aiken, Sloane, & Wu, 2012), financial, and nurse outcomes (Unruh, 2008). She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Short title. Protections are imperfect, but that does not diminish their importance. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm. Journal of Nursing Regulation, 3(3), 36-42. https://doi.org/10.1016/S2155-8256(15)30197-6. (1999). American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. Medical Care, 45(12), 1195-1204. 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. Taylor, J. L. (2010). 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. 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. 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. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. A CNA is not legally sufficient full-shift coverage for patients assigned to an RN. How nurses advocated for their profession in the 86th legislative session. Evidence about workplace violence was needed to understand the scope of the problem in Texas as well. A medical director or member of the medical staff must determine whether the order was reasonable. Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). This report revealed disturbing insights into the prevalence of medical errors in healthcare and the consequences of those errors. Texas House Bill No. 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. Nurses can find themselves in all kinds or risky or potentially dangerous situations. This article is not legal advice. Location of requested conduct/assignment: 4. working mandatory overtime, accepting expanded patient assignments, etc. I reference the ANA Code often with my students! As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. NPAs frame nursing practice by defining a professional scope and educational requirements for 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. Recently our hospital has opened an adult unit as an overflow from the University hospital. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. 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. Consider another situation: You are an experienced nurse. .resBTN a.cpBtn { text-align: center; height: 35px; line-height: 35px;margin: 20px auto 20px;} 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. 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. Registered nurses experience musculoskeletal injuries at a rate of 46.0 cases per 10,000 full-time workers, much higher than the rate for all occupations, 29.4 cases per 10,000 workers based on data from the U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. Notes on Nursing (1969 ed.). (2012). The unit also has 18 general medical beds. The completion of this project is a great example that through the dedication and generosity of all the partners who are working together, we are succeeding in finding concrete solutions to . One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. My apologies for not answering sooner. 192, 2011). The federal level (CMS) requires certain staffing too. History: . B. My question is this. 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