As gaps in protection are identified, nurses work to address them through policy change.As gaps in protection are identified, nurses work to address them through policy change. 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. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. Ask for help and help your colleagues when they are facing an unsafe assignment. Nurse(s) Name(s) invoking Safe Harbor: 2. Yours is a specialization and you cant be transplanted to another area imagine if any of the adult care nurses were suddenly told they had to care for NICU patients without training and supervision. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. The NDNQI provided one of the first databases of patient and nurse outcome indicators and it is currently the only national database containing unit level data regarding nurse sensitive indicators. Safe patient handling U.S. enacted legislation snapshot. 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. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes.Such policies directly support nurse executives, often the decision-makers related to staffing, by offering a flexible approach to planning and budgeting nursing services. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. 6, ANA, 2009). Good luck! 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. Are you unqualified to care for the patients assigned? What else can we do to ensure their care and their safety?. 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. Texas Senate Bill No. Nurse staffing advocacy. The nurses were fired from their positions and were criminally indicted for a third-degree felony (Thomas & Willman, 2012). The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. The federal level (CMS) requires certain staffing too. You tell the supervisor youve never worked oncology. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. 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. doi: 10.1097/01.NNA.0000420390.87789.67, Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney T. (2008). (2012). Unfortunately, many nurses and many leaders will answer the question with some form of suck it up and do the best you can. And while I know that questioning an assignment, let alone refusing it, is hard, this is exactly what you must consider doing. Acqeisising and accepting unsafe or inappropriate practices is equivalent to condoning unsafe practice. (Prov. I hope youll never need it but under current circumstances, you may. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. 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. I am so sorry you are going through this. Retrieved from https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, Texas Constitution and Statutes. They are at the service of the patient and the doctor or another medical supervisor. Online Journal of Issues in Nursing, 12(3). As Director of Practice of the Texas Nurses Association, Ellen supports nurses’ efforts to influence policy through member engagement and assistance, collaboration, and communication. Your license is not a free pass for employers to use you anywhere they feel a need. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. (2019, January 30). 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. Nurses who accept or make assignments must consider patient safety. We conclude by considering the common thread among these exemplars. These challenging situations can cause mental and physical fatigue leading to moral distress. Black (2011) described what, at the time, was thought to be the largest documented patient nosocomial bloodborne pathogen exposure due to inappropriate reuse of equipment and syringes intended for single use. Thank you so much for this article! 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. As gaps in protection are identified, nurses work to address them through policy change. 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. This includes protections for whistleblowers. Insurance companies pay the price for HAIs. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. Cindy Zolnierek, PhD, RN, CAEEmail: cdzolnierek@texasnurses.org. If you have legal questions, please speak with a licensed attorney in your area. As gaps in protection are identified, nurses work to address them through policy change. Here is an example of how the Texas law can work successfully[1]: New Mexico and Texas are the only two states so far that offer a "safe harbor" for nurses who find themselves with possibly unsafe assignments or orders. 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. (2011). Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. 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. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. I work at a Childrens and Womens hospital. Nursing workload and hospital work environment variables, including culture, have a significant impact on the ability of the nurse to provide safe and appropriate care (Kane et al., 2007; Unruh, 2008). (1997). 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). 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. Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. 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. Notes on Nursing (1969 ed.). New Mexico's law was inspired by a Texas law. History: . Willmann, J. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. The Texas law applies to employers of eight or more nurses. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). 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. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Nurse staffing, burnout, and health careassociated infection. Minimum nurse-to-patient ratios in acute care hospitals in California. Retrieved from https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, Brown, J. L. (2010). The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. Table. (2007). Both professional nursing organizations, and individual nurses, must continue advocacy at all levels. I dont understand why any supervisor would put him or herself, the facility, the patients, and the nurses in this situation. Solving tough problems through innovation and proven methodology. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. Board of nursing rules outline the procedures nurses must follow to access these protections. 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. Centers for Disease Control and Prevention (2013). Nurse practice acts guide and govern nursing practice. 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. 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? legislators had difficulty appreciating the reality of violence in healthcare settings. Initially, outcomes data related to nurse staffing was sparse. Tragedy into policy: A quantitative study of nurses' attitudes toward patient advocacy activities. Contrary to what the supervisor said, you have most of the sickest patients on the unit and it is a regular patient care assignment, including administration of chemotherapy for which you are not qualified. This bill did not pass, and work is ongoing to ensure healthcare facilities implement robust strategies that protect not only nurses but all employees. 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. Retrieved from https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, Texas Legislature Online. Your email address will not be published. 61-3A-1. 2011 Session: A roller coaster ride for nursing. Journal of Nursing Administration, 38(5): 223229. 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. The statute was implemented in 2004. 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 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. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. A new law in New Mexico gives nurses another option. Click the topic below to receive emails when new articles are available. 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. 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. A brief history of Florence Nightingale and her real legacy, a revolution in public health. You've successfully added to your alerts. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it. Thank you for your comment. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. (Emphasis added.). All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Nurse researchers are working to describe these relationships and provide guidance for effective staffing models. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). Please confirm that you would like to log out of Medscape. This protects them from facing punitive measures from their employer, losing their nursing license or being sued in court for putting a patients life in danger. Then radiology is taking care of the patient FOR A SHORT TIME. The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. 10.1097/01.Naj.0000305132.33841.92, U.S. Government Publishing Office, 2015 ) addresses the ethical imperative to engage in policy.Advocacy as ethical. Have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves risk... Association has backed the nurses in this situation the code ( ANA safe harbor nursing examples 2015 ) addresses the ethical to! 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