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. For example, a primary care physician and a specialist to whom the . North Carolina enacted the first nurse registration law in 1903. 192: Section 301.413(b-1). Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy most policy work involves collaboration among nurses and other stakeholders. Citation: Martin, E., Zolnierek, C., (January 31, 2020) "Beyond the Nurse Practice Act: Making a Difference through Advocacy" OJIN: The Online Journal of Issues in Nursing Vol. JOIN TNA AND ANA TODAY, 3/1/2023TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, 3/28/2023TPAPN Peer Support Partner Information Session, 3/31/2023Nuts & Bolts of Peer Review Workshop, 4/18/2023TPAPN Peer Support Partner Information Session, Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759, 800.862.2022 | 512.452.0645 | tna@texasnurses.org, Association Management Software Powered by, TPAPN Lunch and Learn: Substance Use Disorder and Mental Health in Nursing, TPAPN Peer Support Partner Information Session. The statute was implemented in 2004. 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. Nurses can find themselves in all kinds or risky or potentially dangerous situations. In Texas, it is called the safe harbor provision and other states, although they may not use that term, have similar policies or statutory wording. Nurses can invoke safe harbor, in good faith, to protect their licenses if they find themselves in compromised practice situations where it is not in the best interest of patients for them to accept an assignment, e.g. Unfortunately, the legal system is just, not fair. 6, ANA, 2009). Nurses are warm, compassionate and forgiving to a fault. 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 make a determination about the situation within 14 days. The Figure offers additional information about Texas patient advocacy and whistleblower protections. Click the topic below to receive emails when new articles are available. Licensure eligibility criteria and the first licensure exam were developed in 1904. 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. 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. Retrieved from https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa . It is Christmas Eve and you report to your unit to work the night shift. doi: 10.1097/01.NNA.0000312773.42352.d7, American Nurses Association. Cates, A. 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. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a "1 nurse to 3 patients" ratio. 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. (2002). There are three variants; a typed, drawn or uploaded signature. Nurse researchers play an important role in policy evaluation by studying the impact of policy changes. With the increasing availability of information about preventable errors and complications of hospital care, particularly those related to nursing care, hospitals were called to higher levels of accountability for patient outcomes. She collected, analyzed, and presented evidence to decision-makers on improved nutrition and hydration, sanitation, and ventilation for hospitalized patients (Kudzma, 2006). Montalvo, I. A., & Spetz, J. Your license is not a free pass for employers to use you anywhere they feel a need. The federal level (CMS) requires certain staffing too. 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. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. Thank you so much for this article! The history of the American Nurses Association. (Read the story of how one nurse worked through TNA to make this possible.). Put your objections or refusal in writing. The American Nurses Association has backed the nurses right to refuse an unsafe assignment since at least the 1980s. (2011). 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. The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances. 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. Workplace violence study. iPhone and App Store are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. 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. The facility must conduct a postoccurrence review of the situation, and cannot retaliate against the nurse for invoking the safe harbor. Beth J. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. 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). most policy work involves collaboration among nurses and other stakeholders.Nursing practice is regulated at the state level, therefore most of the exemplars in this article are from Texas, our state. Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2012). I agree! For a nurse like me who has zero adult experience can I be forced to take care of these patients? NPAs have not remained stagnant over the past century, rather they have evolved but only with the active involvement of nurses in legislative efforts to change statute and update policies related to nursing practice. 394, 1999). The Texas law applies to employers of eight or more nurses. 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. 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. Safe Harbor provides for resolution of the question of safety through a Nursing Peer Review Committee (NPRC). Substance Use Disorders and Related Concerns, The 200th Birthday of Florence Nightingale, Gaul, Higbee, Taylor, Ensign, Monson & Price on Nursing Education and Crisis in Competency, Parast and Heshka on Past, Present, and Future, Fogg-Martin on Calling Nursing Informatics Leaders", Jean-Gilles on An Historical View of Nursing and Polio, Pattishall on Informatics: Protect Yourself and the Nursing Profession from Predatory Journals, Murry, Joshi, & Dolma on Delivering Nursing Care", Baiza and Francis on Exploring Race in Nursing", advocacy to advance professional practice, implications for nursing organizations and nurses, Aiken, Clarke, Sloane, Lake, & Cheney, 2008, Kane, Shamliyan, Mueller, Duval, & Wilt, 2007, Texas Occupations Code Chapter 301, 303, 304, 2019, Texas Department of State Health Services, 2016, https://www.nursingworld.org/ana/about-ana/history/, https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/, https://www.asphp.org/wp-content/uploads/2011/05/SPH-US-Enacted-Legislation-02222015.pdf, https://tshaonline.org/handbook/online/articles/sat02, http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394, https://www.cdc.gov/niosh/topics/safepatient/default.html#safe%20patient%20handling%20legislation%20in%20the%20usa, https://doi.org/10.1016/j.ajic.2012.02.029, http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.html, http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.html, https://www.ncbon.com/board-information-historical-information, https://doi.org/10.1016/S2155-8256(15)30197-6, https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursing_practice_act_pdfs/NPA2019.pdf, https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, https://www.dshs.texas.gov/chs/cnws/Workplace-Violence-Study.aspx, https://capitol.texas.gov/tlodocs/79R/billtext/pdf/SB01525F.pdf, https://capitol.texas.gov/tlodocs/82R/billtext/html/SB00192F.HTM, https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, https://doi.org/10.1016/S2155-8256(15)30203-9, https://www.govinfo.gov/app/details/FR-2003-01-24/03-1293, https://infectioncontrol.tips/2016/06/15/insurance-pay-for-hais/, https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf, https://www.who.int/hrh/news/2019/2020year-of-nurses/en, Nurses Leading the Way to Better Support Family Caregivers, Nurses, Nursing Associations, and Health Systems Evolution in Canada, Learning about Rurality: From Classroom to Community, A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History: Lessons Learned Battling Homegrown Vaccine Hesitancy, Nurses at the Table: Action Now! 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. Several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. Nurses who accept or make assignments must consider patient safety. Implementing nursing's report card: A study of RN staffing, length of stay and patient outcomes. Nurses engaged in a major 2005 legislative effort in partnership with hospitals and nursing homes. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. Journal of Nursing Administration, 38(5): 223229. Then radiology is taking care of the patient FOR A SHORT TIME. 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. 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. An estimated 12-18% of nurses leave the profession due to chronic back pain (Nelson & Baptiste, 2006). We expect that in the coming weeks and months, the health care system will be at capacity or overburdened. Care for the Caregiver resources are available to help nurses balance care for patients with care for family and self. She is active in policy development, actively negotiating legislative approaches to address nursing’s agenda. 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. Texas Nursing Voice, 7(3): 1, 3-4. The BON Comprehensive Written Request for Safe Harbor Nursing Peer Review Form is a sample form that may be used to document the more in-depth information that the nurse must put in writing before leaving the work setting at the end of the work period. Online Journal of Issues in Nursing, 9(3). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Texas Board of Nursing (TBON, n.d.a) clarifies Safe Harbor as a nursing peer review process the nurse may initiate, under good faith, when asked to engage in assignments or conduct the nurse believes to violate Standards of Practice, Duty to Patient, or . 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