A brief history of Florence Nightingale and her real legacy, a revolution in public health. Retrieved from https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, Wallace, N., Cropp, B., & Coles, J. 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. Table. 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). As for the two examples at the beginning, they happened and I was the nurse. The facility must have a process by which to further assess the situation. Licensure eligibility criteria and the first licensure exam were developed in 1904. 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). The federal government provided $4.7 million for this project through CMHC as part of the Canada - Quebec Agreement on RHI. Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. But a nurse can invoke whats known as nursing safe harbor that absolves them of any liability when forced to engage in an activity that could put their career at risk. Example of a Safe Harbor To illustrate a safe harbor accounting method that helps a tax filer sidestep a tax regulation, assume a firm is losing money and cannot thus claim an investment. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. (2004). Nurse practice acts guide and govern nursing practice. (1999). I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. 476. 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. Create your signature and click Ok. Press Done. 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). Protections can be eroded through subsequent legislation or agency rules, and enforcement mechanisms may be weak or non-existent. 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. (2009). 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. The nursing office says it has no one to help you for at least another 4 hours, if that. Black noted that while nurses are accountable for protecting patients from harm, often few protections exist for nurses raising patient safety concerns: employment at-will doctrine places nurses who witness unsafe practices in a difficult catch-22: if they report unsafe practices, they risk losing their jobs; if they dont, they risk losing their licenses. (p. 28). If you are a leader, do not punish the nurse objecting or refusing the assignment. We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Nurse(s) Name(s) invoking Safe Harbor: 2. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). 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. 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. 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. (2016). They can use a. from the Board of Nursings website or any document as long as it contains the following information: The name of the nurses(s) making the safe harbor request and their signature(s), Time and date of when the request was made, The location of where the conduct or assignment is to be completed, The name of the person requesting the conduct or making the assignment, A brief explanation of why the nurse is invoking safe harbor, An assignment or conduct that constitutes a criminal act, An assignment that results in or requires unprofessional conduct, A situation in which the nurse lacks the basic knowledge, skills, and abilities necessary to deliver nursing care that is safe and that meets the minimum standards of care to such an extent that accepting the assignment would expose one or more patients to an unjustifiable risk of harm, 5 Valuable Lessons Every Nurse Must Learn on the Job, How Healthcare Workers Can Better Deal with Moral Distress in the Workplace. Click the topic below to receive emails when new articles are available. This is a free resource for all Texas nurses: 1.800.862.2022, ext.132. These laws gained some notoriety in 2015 over a dispute between U.S. law enforcement and European Union. 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. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations.Hospitals were compelled to focus specifically on safety when in 1999 the Institute of Medicine (IOM) released its groundbreaking report, To Err is Human (Kohn, Corrigan, & Donaldson, 2000). 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. Or go, try, risk making a mistake, and hope for the best? The federal level (CMS) requires certain staffing too. 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. Often policy change involves an incremental approach that requires persistence.An example of incremental work is the many efforts to address workplace violence. The risks are not only damaging to the health of nurses and patients, but also are costly in terms workers compensation insurance and nurse turnover. After Mitchell and Galle were exonerated in a jury trial, nurse advocates went to work to strengthen nurse protections. 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. She is active in policy development, actively assisting policy committees in analyzing issues and developing policy positions. Protection failures represent opportunities for future advocacy. Notify me of follow-up comments by email. Small, H. (2017). Cindys nursing career spans advanced practice, chief nurse executive, and academic roles. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. To invoke safe harbor, the nurse must notify the supervisor in writing that they are invoking safe harbor. My apologies for not answering sooner. B. Nurses are often called to respond to disasters. Why nurses need whistleblower protection. The Texas law applies to employers of eight or more nurses. The legislation prescribes that 60% of the committee seats are filled by direct care nurses to ensure nursing input in staffing decisions. Discussions of nurse staffing followed these trends. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, Dressner, M. & Kissinger, S. P. (2018). Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. Washington, DC: American Nurses Publishing. Required fields are marked *. Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. The nurse may supply supporting documents at a later time; however, the comprehensive details . The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). Nelson, A., & Baptiste, A. S. (2006). 192, 2011). Cindy’s nursing career spans advanced practice, chief nurse executive, and academic roles. We conclude by considering implications for nursing organizations and nurses among these exemplars. Journal of Nursing Administration, 42(10), Supplement: S10S16. What do you do? Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Nurse staffing is resource intensive and is the largest component of hospital operational budgets. In your situation, it is absolutely unwise to assign you to direct patient care for any patients you do not feel qualified to care for. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. Texas Senate Bill No. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . I am not qualified to care for these patients because I dont have the knowledge or the experience. Occupational injuries and illnesses among registered nurses. 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). 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. There are three variants; a typed, drawn or uploaded signature. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. 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. Workplace violence study. Choose My Signature. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. This example represents a missed opportunity for nurses to change practice through policy. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. Remember, the TNA practice hotline line is an available resource for nurses with questions related to nursing practice. 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. A nurse must invoke safe harbor before engaging the act in question. 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. You will receive email when new content is published. Recently our hospital has opened an adult unit as an overflow from the University hospital. Ask for help and help your colleagues when they are facing an unsafe assignment. 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. Up for patient safety when they are facing an unsafe assignment the Texas law applies to employers eight., chief nurse executive, and hope for the two examples at the beginning, they happened and I the! 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