Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). (2007). I hope youll never need it but under current circumstances, you may. Figure. 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. 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). 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. 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. This provision is called Safe Harbor. 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. of nursing care for a defined work period in a defined work setting, including the specified functions, duties, practitioner orders, supervisory directives and amount of . London: MacMillan and Company. 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. Nursing peer review conducted by any entity must comply with NPR Law and with applicable Board rules related to incident-based or safe harbor nursing peer review. What do you do? Has the assignment changed since you accepted it have you received new patients or has a patients condition deteriorated? 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. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. 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. 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. and keep a record of everything. When nurses find themselves in compromising situations, there are resources available to them and laws in place to protect the nurse and their license. A joint investigation by federal and state agencies revealed violation of standard infection control practices. 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. The facility must have a process by which to further assess the situation. 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. North Carolina Board of Nursing. If you are a leader, do not punish the nurse objecting or refusing the assignment. Workplace violence is not limited to emergency departments and nurses in other settings desired similar protections. See Table for examples of these laws. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. As Director of Practice of the Texas Nurses Association, Ellen supports nurses efforts to influence policy through member engagement and assistance, collaboration, and communication. Notify me of follow-up comments by email. 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. 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. 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). Retrieved from https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, Willmann, J. 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. These exemplars describe the impact of nurse advocacy to influence policy that affects nursing practice or the practice environment. You will receive email when new content is published. 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. Dont use subjective or accusatory terms such as short-staffing. Sign it. (2019). The profession of nursing has changed significantly in the 160 years since Florence Nightingales day, but her words still ring true today, Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back (Nightingale, 1914, p. 1). 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). 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). When considering how to proceed in a difficult legal, ethical and professional situation, solid advice grounded in the law, which is backed by the American Nurses Association, is the best way to proceed. Nurses and other front-line health care works will be the most vulnerable populations to the virus. Examples: due to staffing and/or acuity of the patient(s). For example, a primary care physician and a specialist to whom the . 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. RN TO FNP TRANSITION | The First 6 Months. They are at the service of the patient and the doctor or another medical supervisor. The ANA position statement is an excellent resource to start. 61-3A-1. Medical Care, 45(12), 1195-1204. The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Choose My Signature. You submit it to the BON. 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. Nurses are being pulled from the NICU to take care of these adult patients, some of which have tracheostomies, closed head injuries, etc. You fill out a form that basically says that your work environment is unsafe and you will continue to care for your patients to the best of your ability, but are not held responsible for mistakes that are made. Neither are nurses legal, professional, and ethical duties. We offer these to affirm the work of these nurses and organizations as we celebrate nurses this year. These challenging situations can cause mental and physical fatigue leading to moral distress. working mandatory overtime, accepting expanded patient assignments, etc. Objections must be in writing so check to see if your facility or state has a form and keep several blank copies in your locker or backpack. Centers for Disease Control and Prevention (2013). Texas Nursing, 89(3), 7-9, 17. Neither the author or the website publisher are responsible for any actions a reader may take based on material in this article or on this website. I am concerned for the patients safety and I need your help to find a safer way to take care of these patients. I cannot accept this assignment because my lack of knowledge or experience will put these patients at risk of harm. Despite this emphasis, nurses do not often consider how policy affects the professional nursing role (Taft & Nanna, 2008). 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A. 1) describes the organizations history starting in 1896 as the story of individual nurses everywhere united in common cause to advance nursing practice. Board of nursing rules outline the procedures nurses must follow to access these protections. Responding to a disaster is a familiar process for several nurses in Texas. While the Medicare Conditions of Participation (68 Federal Register 3435, 2003) have long required hospitals to have policies in place to ensure adequate nurse staffing, specific policy has lagged. This encompasses a wide range of potentially dangerous situations and criminal activity, including tampering with medical records, putting the patient, the nurse or another persons life in danger, or committing a crime of some sort. 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. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. Nurses are warm, compassionate and forgiving to a fault. This website also contains material copyrighted by 3rd parties. As gaps in protection are identified, nurses work to address them through policy change. In Handbook of Texas Online. A nurse is free to invoke safe harbor at any time during their shift, including if an assignment changes along the way. 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. 1525. Safe Harbor Forms - Nursing Peer Review. Decision Tree for Invoking Safe Harbor and ACCEPTING an Assignment nursing supervisor violation of a nurse's duty to a patient, or a . (2016). ISSN: 1091-3734 American Nurses Association - 8515 Georgia Avenue - Suite 400 - Silver Spring, MD 20910, Susan C. Reinhard, RN, PhD, FAAN; Andrea Brassard, PhD, FNP-BC, FAAN, Michael Villeneuve, MSc, RN, FAAN ; Claire Betker, PhD, MN, RN, CCHN(C), Ruth Mielke, PhD, CNM, FACNM, WHNP-BC; Sue Robertson, PhD, RN; Juliana van Olphen Fehr, CNM, PhD, FACNM, Sofia A. Aragon, JD, BSN, RN; Gerianne M. Babbo, EdD, MN, RN; Sarah J. Your email address will not be published. or local laws, rules or regulations affecting the nurse's current area of nursing practice. please help the nurses reason legally to this unsafe patient services. Texas Senate Bill No. They reported first to hospital administration and then to the Texas Medical Board after their concerns were not addressed. 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. American Nurses Association. Consider another situation: You are an experienced nurse. Failure to AdvocatePolicies that protect nurses who advocate for patients are a vital element of safe healthcare delivery.Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. Please see our, You are being redirected to Medscape Education, Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: HPV Is Probably Not at the Top of Our List. Safe Harbor Nursing Peer Review (Texas Occupations Code 303.005, 2019) protects nurses who believe in good faith that they are being requested to engage in conduct that would violate a nurses duty to patient as defined in the board of nursing rules on standards of professional practice and unprofessional conduct. Reflect the views of WebMD or Medscape nurses and organizations as we celebrate nurses this Year investigation! 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