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Can a nurse invoke Safe Harbor? If so, how do nurses invoke Safe Harbor? Although the Board of Nursing BON has no authority over workplace policies, such as floating or staffing ratios, nurse staffing was addressed in SB during the 81st Legislative Session in If you work in a hospital, this law is applicable to you and requires hospitals to have a nurse staffing committee, policy and plan to ensure that an adequate number and skill mix of nurses are available to meet the level of patient care needed.
The law further states that the staffing plan must include a method for adjusting the staffing plan for each patient care unit to provide staffing flexibility to meet patient needs; and include a contingency plan when patient care needs unexpectedly exceed direct patient care staff resources.
Floating can be the strategy that meets the intent of the law.
Nurses that may be required to float to assist another unit or confronted with a potentially unsafe practice situation should be familiar with the Standards of Nursing Practice, found in Board Rule Standard 1 B requires the nurse to maintain a safe environment for the patient.
This requirement supersedes any agency policy or physician order; also see Position Statement Duty of a Nurse in Any Practice Setting.
Standard 1 Pin situations where nurses are floating, working double or extra shifts, taking charge duties, or working short-staffed, clear communication between staff and supervisors is essential to manage patient care and decrease conflict in the work setting. Standard 1 S applies to charge nurses or nurses who are in management positions.
This standard requires the nurse who is supervising other nurses to make assignments that take into account the educational preparation, knowledge, skills, physical, mental and emotional abilities of the nurses for whom the supervisor is administratively responsible.
If the nurse accepts an assignment, then they are responsible for the nursing actions and care delivered.
Standard 1 U holds supervisors responsible to oversee the nursing care provided by others for whom the supervisor is professionally responsible. Safe Harbor ensures that a group of nursing peers examines the assignment the nurse was asked to accept and determines whether the nurse was being asked to accept an assignment that was unsafe and or outside of his or her knowledge, skills, and physical or emotional abilities.
Safe Harbor is invoked at the time the nurse is asked to engage in an activity or an assignment that the nurse believes is not safe for patients.
Safe Harbor cannot be invoked after a patient has been hurt or after the shift is over and done. Safe Harbor Peer Review is an internal process, between the nurse and the employer. Safe Harbor must be invoked prior to engaging in the conduct or assignment. The required information is then submitted to the nurse manager.
Board staff recommends that the nurse invoking Safe Harbor keep a copy for future reference. In addition to the Quick Request Form, the nurse must complete the Comprehensive Written Request for Safe Harbor Peer Review before leaving the work setting at the end of the work period.
See Board Rule The BON does not get involved with Safe Harbor Peer Review, but may be involved after-the-fact if peer review is not conducted in good faith. The nurse may wish to seek legal counsel for advice on employment issues. The BON cannot provide legal advice, and has no authority in civil matters.
Safe Harbor promotes patient safety and collaborative problem solving. The Peer Review Committee can be a catalyst for positive changes, resulting in improved staffing systems.
Safe Harbor can be found in Board Rule If a nurse has concerns about staffing patterns or floating on a daily basis and the potential for patient harm, the nurse may wish to consider speaking with the nurse manager for collaborative problem solving before an untoward event occurs.
It helpful to utilize some of the information requested on the safe harbor form to initiate discussion surrounding the concerns about floating to areas outside of the clinical expertise and or area of competence.
Board staff recommends that nurses active engage in collaborative problem solving, generating ideas and solutions that promote flexible staffing without jeopardizing patient safety or pose the potential for nursing licenses.
Board staff recommends consulting the nursing literature for published evidence- based staffing strategies that promote patient safety.BIG NEWS (not really): Advanced practice providers are changing access to healthcare.
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