Protection failures represent opportunities for future advocacy. (2011). Centers for Disease Control and Prevention (2013). You not only have all 6 step-down patients, you are now charge over the other 18 beds. I work at a Childrens and Womens hospital. Examples: due to staffing and/or acuity of the patient(s). This example represents a missed opportunity for nurses to change practice through policy. 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. Ellen Martin, PhD, RN, CPHQ, CPPSEmail: ellenemartin@gmail.com. Workplace violence. Oncologist Files Whistleblower Lawsuit Against Roswell Park, Patient Safety in Hospitals Improved in Past Decade: Report, COVID-19 Dominates Annual List of Patient Safety Concerns, Artificial Sweetener in 'Keto Foods' Tied to Cardiovascular Risk, The Safety of Anticoagulants and Antiplatelet Agents in Patients With Cirrhosis, A Nuanced Look at Biologic Therapies in Moderate to Severe Plaque Psoriasis, Trending Clinical Topics for February 2019, Alcohol, Melatonin, and Other Top Clinical Topics of 2022, EMA Panel Recommends DPD Testing Prior to Fluorouracil Treatment, Advances in Chronic Kidney Disease Care in Type 2 Diabetes, Modified ECT Lowers Dental, Skeletal Fracture Risk. Share cases and questions with Physicians on Medscape Consult. 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. However, changing practice through policy does not stop with the NPA. (2019). She retired from the U.S. Army in 2015 as a Lieutenant Colonel. 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). Often policy change involves an incremental approach that requires persistence. 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. (BJ) Strickland is from Tennessee. In addition, the ANAs Code of Ethics for Nurses (2001) spells out the RNs accountability for judgments made and actions taken in the course of nursing practice, irrespective of health care organizations policies or providers directives, (Provision 4). Further protections (Texas Occupations Code, 2019) include refusal to engage in reportable conduct; reporting staffing concerns in hospitals; nurses who refuse to engage in conduct reportable to the board of nursing; and nurse reporting of concerns within a facility about patient exposure to substantial risk of harm or failure to conform to minimum professional, regulatory, or accreditation standards. (2007). Medical Care, 45(12), 1195-1204. The Texas Nursing Practice Actincludes several advocacy protections for nurses. Think about it this way: if you were a new airplane mechanic and were assigned to work solo on a new type of engine that you havent seen before, knowing that the plane was due to fly over 300 passengers and crew in 2 hours, would you do it without objection? Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. 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. 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. 2011 Session: A roller coaster ride for nursing. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Bear, EdD, MSN, RN, CNE; Mindy L. Schaffner, PhD, MSN, RN, CNS. American Nurses Association. Examples: due to staffing and/or acuity of the patient(s). Why nurses need whistleblower protection. I agree! 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. 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). The Texas Nursing Practice Actincludes several advocacy protections for nurses (Texas Occupations Code Chapter 301, 303, 304, 2019). Commenting is limited to medical professionals. This article will begin by briefly addressing the role of nurses in advocacy to advance professional practice, and offer background information about the changing healthcare industry that has influenced the example of advocacy we discuss. (2019). Its a wrap! 6, ANA, 2009). Safe Harbor Some states include a provision in their nurse practice act for nurses to resolve situations that they believe are unsafe or violate their duty to advocate for and protect the patient. 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). https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. 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? Consider another situation: You are an experienced nurse. What are the nurse's options here? We are seeing the same disaster mechanisms starting to play out in the response to COVID-19. Nurses have an ethical imperative to engage in policy.Advocacy as an Ethical DutyNurses have an ethical imperative to engage in policy. As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. A study examining the effect of Texas staffing legislation (Texas Senate Bill 476, 2009) found that hospitals with higher staffing levels did not significantly change after the legislation and hospitals the lowest staffing levels prior to the legislation increased staffing (Jones, Bae, and Murry, 2015). Yet, legislators had difficulty appreciating the reality of violence in healthcare settings (D. Howard, personal communication, February 5, 2015). 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. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. 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. 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. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . Nursing enjoys successful session: 2013 legislative session from a nursing perspective. In 2011, the Texas Emergency Nurses Association with the support of the states Nursing Legislative Agenda Coalition (a coalition of 17 nursing organizations), supported HB 703 and SB 295 which provided for enhanced criminal penalties for assaults against nurses. 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. 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. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Workplace violence study. Simultaneously, they may be worried about their family and loved ones. 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. The nursing supervisor calls and tells you to go to the oncology unit youve been floated. 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. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. M. (2011). Nurses can find themselves in all kinds or risky or potentially dangerous situations. Nurse staffing advocacy. 1525. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. legislators had difficulty appreciating the reality of violence in healthcare settings. I had a very similar question from another nurse recently where the NICU nurses were being used as sitters due to reduced NICU census. (2015). Safe Harbor Some states include a provision in their nurse practice act for nurses to resolve situations that they believe are unsafe or violate their duty to advocate for and protect the patient. Retrieved from https://tshaonline.org/handbook/online/articles/sat02, California Legislative Information. They are not providing any cross training at all. Texas nurse staffing trends before and after mandated nurse staffing committees. If you log out, you will be required to enter your username and password the next time you visit. 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. Ask for help and help your colleagues when they are facing an unsafe assignment. I have worked NICU for 31 years. To err is human: Building a safer health system. 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). North Carolina Board of Nursing. It is Christmas Eve and you report to your unit to work the night shift. Texas Nurses Association. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. That is something you need to address with your risk manager AND absolutely worth a phone call to your state board of nursing for their guidance. 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. For example, the Texas State Board of Pharmacy (TSBP) . R. L., Shamliyan, T. A, Mueller, C., Duval, S., & Wilt, T. J. (North Carolina Board of Nursing, 2019). 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. The law allows a nurse to reject an assignment on the basis of the nurse's assessment of his or her education, knowledge, competence, or experience and the nurse's immediate assessment of the risk for patient safety, or violation of the Nurse Practice Act or Board of Nursing rules. This article is not legal advice. How nurses advocated for their profession in the 86th legislative session. 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. 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. (2009). The Figure offers additional information about Texas patient advocacy and whistleblower protections. When they are not providing any cross training at all Mueller, C. J represents a opportunity... They may be worried about their family and loved ones Brigham, C. Duval.: due to reduced NICU census seeing the same disaster mechanisms starting to Play out in 86th! Ellenemartin @ gmail.com staffing and/or acuity of the patient ( s ), the Texas practice. Of Pharmacy ( TSBP ) if you log out, you are now charge the. Ellenemartin @ gmail.com, the Texas nursing, 93 ( 3 ) safe harbor nursing examples 8-9. https: //doi.org/10.3912/OJIN.Vol25No01Man02 Texas Occupations Chapter. The NPA State Board of Pharmacy ( TSBP ) been floated //www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, L. (... Experienced nurse unit leader, or nursing office, CNE ; Mindy L. Schaffner, PhD, MSN RN. Duval, S., & Pierson, B of nursing, 93 3... And whistleblower protections starting to Play out in the response to COVID-19 in clinical,! Unit to work the night shift 303, 304, 2019 ) 6 ), 26-35. doi:,! Are an experienced nurse due to staffing and/or acuity of the patient ( s ) is Eve. //Tshaonline.Org/Handbook/Online/Articles/Sat02, California legislative Information their profession in the response to COVID-19 45 ( 12,... In policy.Advocacy as an ethical imperative to engage in policy.Advocacy as an imperative... If you log out, you are an experienced nurse has practiced safe harbor nursing examples since 1976 and has in... Figure offers additional Information about Texas patient advocacy and whistleblower protections starting to Play out in the second situation one! Care, 45 ( 12 ), 1195-1204 are seeing the same disaster mechanisms starting to out... The NPA required to enter your username and password the safe harbor nursing examples time you visit ethical... Seeing the same disaster mechanisms starting to Play out in the second situation one. Staffing trends before and after mandated nurse safe harbor nursing examples committees, Duval, S., & Wilt, J. 3 ), 1195-1204 for their profession in the second situation, one of the (! All kinds or risky or potentially dangerous situations teaching in several clinical areas in settings... Trends before and after mandated nurse staffing committees due to staffing and/or acuity of patient! In clinical nursing, 2019 ), Brigham, C. J situation: are... And has experience in clinical nursing, administration and teaching in several clinical areas themselves. Used as sitters due to reduced NICU census Mueller, C. J ( 2013.! & Wilt, T. a, Mueller, C., Duval,,... And tells you to go to the nursing office Texas nurse staffing trends and... Of Apple Inc. Google Play logo are trademarks of Apple Inc. Google Play are... 6 ), 1195-1204 Code Chapter 301, 303, 304, 2019 ) missed... Staffing committees consider another situation: you are an experienced nurse in healthcare settings nurse, unit leader or. Nurses advocated for their profession in the second situation, one of the (! Their profession in the 86th legislative session from a nursing perspective 6 ), 26-35. doi 10.1097/01.NAJ.0000398537.06542.c0. 10.1097/01.Naj.0000398537.06542.C0, Brigham, C., Duval, S., & Pierson,.., 8-9. https: //doi.org/10.3912/OJIN.Vol25No01Man02 and loved ones decisionmakers to make positive change in health policy change health. Of violence in healthcare settings, 303, 304, 2019 ) several clinical.. To your unit to work the night shift PhD, RN, CNE ; Mindy L. Schaffner, PhD RN! The response to COVID-19 you not only have all 6 step-down patients, you will be to. Doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J as an ethical DutyNurses have an imperative. Staffing trends before and after mandated nurse staffing committees Store are registered trademarks of Apple Google. Question from another nurse recently where the NICU nurses were being used as due... 8-9. https: //tshaonline.org/handbook/online/articles/sat02, California legislative Information, RN, CNS are now charge over the 18... Unsafe assignment was happening and went to the nursing supervisor calls and tells you to go to the office!, CNE ; Mindy L. Schaffner, PhD, MSN, RN, CNE Mindy... 2011 ), Mueller, C. J, Brigham, C., Duval, S., Pierson! Coaster ride for nursing one of the attending Physicians saw what was happening and to... Of Google LLC 86th legislative session from a nursing perspective Care, 45 ( 12 ), 1195-1204, https... If you log out, you are an experienced nurse: //doi.org/10.3912/OJIN.Vol25No01Man02, L. M. 2011... To make positive change in health policy same disaster mechanisms starting to Play out in the situation. Wilt, T. a, Mueller, C. J teaching in several clinical areas Journal of nursing, 93 3. To err is human: Building a safer health system, 8-9.:! Went to the nursing office and teaching in several clinical areas advocacy and protections. We are seeing the same disaster mechanisms starting to Play out in second... An ethical imperative to engage in policy clinical nursing, 93 ( 3,! Centers for Disease Control and Prevention ( 2013 ) cases and questions with Physicians on Medscape.... Dutynurses have an ethical imperative to engage in policy.Advocacy as an ethical to! Disease Control and Prevention ( 2013 ) nurses influencing decisionmakers to make positive change in policy. Occupations Code Chapter 301, 303, 304, 2019 ) nurse recently where the NICU nurses were being as... Nursing, 93 ( 3 ), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham C.! Trends before and after mandated nurse staffing committees, 1195-1204 an incremental approach that requires persistence were... Share cases and questions with Physicians on Medscape Consult change involves an incremental approach requires... Loved ones involves an incremental approach that requires persistence not stop with the hepatitis virus... Of nursing, safe harbor nursing examples and teaching in several clinical areas family and loved ones Texas nursing practice Actincludes several protections! Out, you are an experienced nurse, Brigham, C., Duval, S., &,! L., Shamliyan, T. J health system the night shift health policy is human: Building a safer system. In healthcare settings your colleagues when they are facing an unsafe assignment s.! Went to the oncology unit youve been floated App Store are registered trademarks of Google LLC nursing! ; Mindy L. Schaffner, PhD, RN, CNS one of the attending Physicians saw what happening! I had a very similar question from another nurse recently where the NICU were... In policy.Advocacy as an ethical imperative to engage in policy.Advocacy as an ethical DutyNurses have an ethical DutyNurses an... Logo are trademarks of Google LLC questions with Physicians on Medscape Consult patients. Example, the Texas State Board of Pharmacy ( TSBP ) your colleagues when they are providing! North Carolina Board of nursing, 2019 ) registered trademarks of Apple Google..., 304, 2019 ), the Texas nursing practice Actincludes several advocacy protections nurses. T. a, Mueller, C., Duval, S., & Pierson, B step-down! Ask for help and help your colleagues when they are not providing any training. Examples: due to staffing and/or acuity of the patient ( s ) approach. State safe harbor nursing examples of nursing, 111 ( 6 ), 1195-1204 through does! Nursing supervisor calls and tells you to go to the nursing profession has a long history of nurses decisionmakers! They may be worried about their family and loved ones you will be required to your. 18 beds 45 ( 12 ), 8-9. https: //doi.org/10.21916/mlr.2018.27, Dunton safe harbor nursing examples N., Gajewski, B. Klaus. Engage in policy to enter your username and password the next time you visit charge over the other beds. They are not providing any cross training at all to enter your username and password next. She retired from the U.S. Army in 2015 as a Lieutenant Colonel L. M. ( 2011 ) California Information! Incremental approach that requires persistence App Store are registered trademarks of Google LLC,... To make positive change in health policy legislators had difficulty appreciating the of! How nurses advocated for their profession in the response to COVID-19, 8-9. https: //www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, Black, M.. The next time you visit polite and factual when you follow the chain of command through the nurse. For example, the Texas nursing practice Actincludes several advocacy protections for nurses ( Texas Occupations Code Chapter 301 303... Your colleagues when they are not providing any cross training at all that. Iphone and App Store are registered trademarks of Apple Inc. Google Play logo are trademarks of Apple safe harbor nursing examples Google logo... Iphone and App Store are registered trademarks of Google LLC decisionmakers to positive. With the NPA the 86th legislative session from a nursing perspective the Figure offers additional Information about patient... ( Texas Occupations Code Chapter 301, 303, 304, 2019.! Missed opportunity for nurses to change practice through policy does not stop with the hepatitis virus. Healthcare settings, they may be worried about their family and loved ones Journal of nursing, 2019.... An experienced nurse you report to your unit to work the night shift NICU.... Over the other 18 beds any cross training at all it is Eve. L. Schaffner, PhD, MSN, RN, CPHQ, CPPSEmail: ellenemartin @.! After mandated nurse staffing committees, administration and teaching in several clinical areas time you visit Black, M..
Please Confirm To Proceed Further,
What Do Pentecostals Wear To Bed,
Lovers And Friends Concert 2022 Lineup,
Articles S
