Nursing Safe Harbor Rule

The Safe Harbor Rule (SHPR) is a nursing peer review process that can be initiated by a nurse when asked to participate in conduct that has the potential to result in one or more violations of Texas Board of Nursing rules and statutes. Nurses Career Support Article

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Nursing Safe Harbor Rule

All nurses who either create or assume responsibility for patient assignments should always look at the big picture and factor safety into the equation first and foremost. However, a gray area sometimes exists in different areas of nursing where individual nurses may hold inconsistent views regarding what counts as 'safe' and 'unsafe' practice. Nursing staff members in Texas have the right to invoke Safe Harbor if they think certain assignments, orders, directives, or other conduct requested of them is unsafe.

The Safe Harbor Rule (SHPR) is a nursing peer review process that any type of nurse (licensed vocational nurse or registered nurse) can initiate in good faith whenever asked to take part in assignments or conduct that might result in one or more violations of Texas Board of Nursing rules and statutes. The Safe Harbor Rule was put in place to prevent retaliation by employers and shield the nurse's licensure from action by the Texas BON when an RN or LVN reports practices or assignments that they believe may detrimentally affect the manner in which nursing duties are carried out.

Safe Harbor blazes a pathway to help clear up questions surrounding safe practice by way of a nursing peer review committee (NPRC). The LVN or RN shall invoke Safe Harbor prior to taking the assignment and be safeguarded from employer retaliation and disciplinary action from the BON while awaiting the peer review committee's findings. The nursing peer review committee needs to arrive at a decision no later than 14 days after the initial Safe Harbor invocation.

Instances of reportable Safe Harbor issues include assignment / staffing problems that the nurse believes are unsafe, and directives from management or colleagues to participate in activities that are illegal. Nurses should refuse to perform illegal tasks at all times. And according to the Texas Board of Nursing website, Safe Harbor also has a structured process for nurses to request that a determination be made on the medical reasonableness of physicians' orders.

To utilize Safe Harbor, the nurse makes the supervisor aware of his / her intent to invoke at the time he / she is asked to take part in the assignment or activity. The nurse should fill out the BON's quick request forum. Visit the Texas BON website to download appropriate forms. Keep in mind that some facilities strongly discourage nurses from invoking Safe Harbor.

An instance of a successful Safe Harbor invocation:

A freestanding psychiatric hospital has a census of 35 patients on the chemical dependency unit. The chief nursing officer cut night shift staffing from five full-time registered nurses down to two. The two full-time night shift nurses believed that patient safety was placed in jeopardy due to the decreased staffing and ensuing increase in tasks. One of the night shift nurses invoked Safe Harbor at the beginning of the shift and notified her supervisor. She continued to provide care for the 35 psychiatric patients with the other nurse until reporting off to the day shift nursing staff at 7:00am.

The nursing peer review committee met two days later and concluded that the staffing assignment of the night shift nurses violated their duty to provide safe, effective care. The hospital's chief nursing officer accepted the findings of the committee and made changes by assigning two more full-time nurses to night shift on the chemical dependency unit for a grand total of four nurses for 35 patients.

RESOURCES

Texas Board of Nursing

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TheCommuter

About TheCommuter, BSN, RN

TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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Specializes in NICU, PICU, PCVICU and peds oncology.

How I wish it were that simple here. We have similar provisions (not legislated but collectively agreed upon) but too many nurses are intimidated by management into abandoning their concerns without reporting them. It's not only unfair but callous of management to expect nurses to continue to function in situations where either patient or staff safety is jeopardized. We know that should the inevitable by-product-of-digestion-meets-oscillating-air-movement-device occur, our regulatory body will go for the throat and our administration will be handing them the knife. Not a good time to be a nurse around here.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
janfrn said:
How I wish it were that simple here. We have similar provisions (not legislated but collectively agreed upon) but too many nurses are intimidated by management into abandoning their concerns without reporting them. It's not only unfair but callous of management to expect nurses to continue to function in situations were either patient or staff safety is jeopardized. We know that should the inevitable by-product-of-digestion-meets-oscillating-air-movement-device occur, our regulatory body will go for the throat and our administration will be handing them the knife. Not a good time to be a nurse around here.

Well, things are not exactly easy here, either. Although we have the Safe Harbor rule, management at many facilities strongly discourages nurses from utilizing this protection to avoid dealing with the ensuing peer review.

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Specializes in Critical Care.

Doesn't Texas have some group I can't recall the name of it that blacklists nurses and makes it very difficult for them to get a job if they are put on the list? Wouldn't said nurses that speak up end up on that list?

I suppose it's better than nothing, but what happens if the board decides against you? Then do you face retaliation? I personally would prefer a strong union with a collective bargaining process such as the NLN vs either Safe Harbor or Shared Governance!

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
brandy1017 said:
Doesn't Texas have some group I can't recall the name of it that blacklists nurses and makes it very difficult for them to get a job if they are put on the list? Wouldn't said nurses that speak up end up on that list?

Group One is the name of this organization. They are based in a suburb of Dallas.

I agree with you that a strong union would do more wonders for working conditions than either Safe Harbor or shared governance.

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I agree that the peer review process is a failure. The state board failed nurses when they put a ruling out without first determining how it was to be safely and effectively implemented and managed. Historically, nurses are victimized by employers for doing the right thing. It is common place for nurses to be threatened, terminated, taunted, and ridiculed for trying to do the right thing. Shared Governance is a good idea in concept, as is peer review, but to say that that answer is a union is not the answer. We do not need to pay big dollars to a few individuals to make the rules and threaten employers. The reality of it is that we are well educated professionals who can stand together to make the necessary changes. We shouldn't hide behind threats of union bosses. They don't work and we don't need this type of organization to speak for us. Check out Nurse Advocacy Association. This is where the change will come from, not unions!

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Texas nurses need to check out the new nursing association 'Nurse Advocacy Association', this is where real change will come happen. Not power hungry unions. Unions are not the answer to our problems, nurses do need to ban together to fight for real change and it won't take a union to do it.

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Specializes in Oncology; medical specialty website.

The nurses still lost; they're down one staff nurse.

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in the first organization i worked at, my unit was almost assigned to 1:8 in critically busy M/S floor... thank god we had float from somewhere else. I asked some experienced nurses about invoking safe harbor, and they said: you can invoke safe harbor, but after that the hospital will find any (ANY) reason to terminate you, because "legally", they can't retaliate, but still can terminate you for stupid little thing... we need union in TX...

so, best to find a good organization and good unit.

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Unions are not the answer to our problems but merely a transfer of power from one entity to another. The fundamental problems are never corrected. Nurses can fix the problems in nursing without using collective bargaining tactics. Let's start working together to correct our problems without paying high-dollar union leaders to do what we can do together. NAA is the organization that will take a tough stance for nursing and the practice environment. Don't get sucked into the collective bargaining hype that the ANA is throwing out there. Afterall, unions didn't help Detroit from going bankrupt.

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Hi, commuter. I am a new nurse, LVN. Worked on a Skilled/Rehab Medicare hall in a facility in Galveston. I filled out a "safe harbor"quick request form because they had a man I could no longer keep safe. He required every minute of my attention and when I assigned him to be watched by CNA's I found him backed against a wall with a table in front of him and he was attempting to climb over the side of his w/c and if he had succeeded he would've fallen as usual. I didn't want to get all "legal" on them but needed something to be done because I couldn't continue to take him to every room and park him at the door and monitor him from behind the privacy curtain while giving injections and doing blood sugars, etc.

I handed the form to the DON when I started my shift one night but she leaves when I get there. The next evening I asked a supervisor (he was in MDS) about my form and he said "its being investigated". I told him I thought there was a pretty quick turnaround time required and he said "its being investigated". I saw the DON and asked her about the form and she informed me they had put the man in a BROCA chair, basically one that would allow us to partially recline him in the hopes he couldn't manage to get up.

It didn't stop him in the least and the DON had left again. I charted both nights about the problem. I was off for 2 days and when I returned for my next shift I was called in to the DON's office and she fired me. The reasons listed were: didn't fill out a TB form properly. Didn't finish admits correctly, didn't complete nurses notes in the correct manner, and made inappropriate comments to family members, which some examples were given and they were almost laughable.

All of the admin/paperwork issues they cited I had filled out and completed just exactly as I was shown to do by my charge RN and had been doing all along. I even had a "sample" form I found for the TB test and it is just the way I filled it out. I had found a protocol for admits and had been doing them just as outlined.

I had never had any discussion about any of these things prior to that day, or been corrected before about any of them. I had never been written up and had never been late. My termination was inconsistent with written company policy on disciplinary processes which all talk about "progressive discipline" etc. I worked there full-time for a little over 60 days and was basically a model new nurse who was concerned about my patient's safety. I know they can fire me with or without cause but I believe I am being retaliated against and I know I have whistle-blower protection from the state of TX for safe harbor.

Like I said I am a new nurse. But I was a drug rep for 30 years. I am not any spring chicken - retired and went to nursing school because I wanted to serve God. That was only my 2nd job nursing - I only passed my boards last July.

So my question is this: Where in the world do I turn for some advice or advocacy? The TX BON told me to call the "safe harbor" phone number which they provided me with and it was basically the TX Nurse Association which does not represent LVNs. I contacted another org I found online = NFLPN and they never got back to me. Is there some place that can at least recommend a lawyer who does this type of work or can offer me counsel. I don't have an axe to grind I just want to follow-up on this because it has merit. I do not qualify for unemployment benefits because my base period was the 4 quarters ending in 2014 and I was in school or unemployed almost the entire time. If there is nothing to be done, fine. I have no anger issues, and know God has something better for me soon.

Edit - I do not know how to explain how I didn't see the comments on your article already written. In the comments I picked up the names of 2 places I can check out and I wanted to apologize for not checking them out before writing this comment. ( nurse advocacy ass and group one) Thank you so much

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Gal 2:20 said:
I worked there full-time for a little over 60 days

First of all, I am so very sorry your employment was terminated. In the real world of nursing, some managers are unethical and/or simply dislike nurses who invoke Safe Harbor because they perceive you're creating an inconvenience for them.

Unfortunately, since your employment was terminated during the typical 90-day new hire probationary period, there's not much you can do. During the first 90 days of at-will employment, you have the right to resign at any time for any reason and the employer has the right to terminate your employment at any time for any reason.

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