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.
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.
I think that PPs may be confusing Safe Harbor protections with governmental protections for Whistle Blowers. Safe Harbor is strictly limited to nursing practice issues & must be invoked at the onset of an assignment. The 'short form' must be followed with submission of the 'long form'. All SH incidents must be reviewed by the organization's Peer Review Committee. If Peer Review is not being administered properly, the Nurse Leader (DON, CNE, CNO, etc) is in violation of the Nurse Practice act... specifically, "unprofessional conduct" and her/his license could be in jeopardy. So, if any Tx nurse believes that these mandatory functions (Peer Review & Safe Harbor) are not being managed according to the law - this needs to be reported to the BON. This would take courage, because the 'reporter' would not be covered by any Whistleblower protections - which are specifically connected to compliance with Federal/State regulations, not BON.
Texas mandated Peer Review because we are the ONLY state with a legally defined Nurse-Patient duty (since 1984). As a result of that legislation, the BON's mandate for monitoring individual practice increased dramatically -- but of course, no additional resources were forthcoming to manage all the extra work. So, Tx created a process whereby the Peer Review process would begin at the local/employer level & only 'serious' issues would be taken on to the BON level. It works very well if an organization manages it correctly. I believe that Kansas also has mandated Peer Review now... so that makes 2 states.
I also want to point out that Safe Harbor protection is not just for bedside nurses. It can be applied whenever a nurse is asked to do something that s/he believes is contrary to out NPA. For instance, if a nurse educator is asked to train non-nurses to perform a nursing-only task, he could declare Safe Harbor so that the issue could be formally reviewed. All of us need to be very familiar with our NPAs - especially as they relate to our everyday work.
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!
Clarification - Group One is a commercial product, used by very few organizations - mostly in the DFW area. I haven't heard of any clients in the Houston area.
The Board will decide "against you" if you have violated the Nurse Practice Act. Using Safe Harbor does not mean that a nurse is not held accountable for mistakes or errors which are the result of the individual's own decisions. This is not 'retaliation'.
Thank you for your reply. From what I understand, whether 30, 60, 90 days or 6 years employment, the organization can terminate your employment with or without cause. Likewise, an employee can resign with or without cause.
Unless the employer has violated Federal laws that protect certain classes of workers (those with disabilities, older age, etc.) or specific discriminatory practices (race, sexual harassment, etc.) being in an "employment at will" state such as Texas gives both parties protection from "wrongful termination".
If I am wrong about this, please correct me.
What my post was about was specific to being retaliated against for invoking safe harbor. I realize I did not follow the BON's rules with respect to getting a signature on the form, or following up the "quick request" with the long form. ( I did fill out the long form but never turned it in hoping to discuss the issue with the DON in an effort to come to some sort of agreement about the case in question)
I don't think that my failure to follow the "safe harbor" steps/timeline prohibits me from the protection of being retaliated against, though. The fact remains, I did hand the quick form to her and the facility did not conduct a peer review.
UPDATE: The TNA did call me back (God love them) and told me that I could find the advocacy/advice I am looking for at LVNAT.org which is a TX org specific to LVN's. I thank you again for your timely reply and concern. I was actually pretty amazed at how quickly my post got a couple of responses being a bit skeptical it would even be seen considering I was posting on a thread that had it's last replies in 2013.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Gal 2:20 said:
From what I understand, whether 30, 60, 90 days or 6 years employment, the organization can terminate your employment with or without cause. Likewise, an employee can resign with or without cause.
Here's the caveat: employers generally dislike terminating one's employment without just cause after the probationary period has elapsed because it exposes them to the potential of expensive litigation.
During the first 90 days, employers are less leery about 'canning' someone because this is generally known as the probationary period in which both parties are feeling each other out for the presence of an optimal fit. However, after the probationary period, employers who want to rid themselves of an employee usually generate a lofty file (a.k.a. paper trail) of documented progressive disciplinary action that will hold up in a court of law.
You've found out the hard way that many managers dislike nurses who invoke Safe Harbor. Although it's a travesty, it is what it is.
Firstly, what are "PPs"? ( you wrote: "PPs may be confusing Safe Harbor protections with governmental protections for Whistle Blowers" )
I have been reading quite a bit on the BON's website concerning this issue ( pretty dry reading, it is..) and am trying to get my head around where I need to go from here. I have been blessed to have savings from my previous career which kind of takes the urgency off of the job search so I can spend some time looking into this issue....
You mention it would take "courage" because the reporter would not be covered by whistleblower protections.. but I am unclear as to what the risk is to me ( as a "reporter")? I have already been terminated, is there something else I am just not seeing? And doesn't the BON offer protection from retaliation as long as the employee operated in "good faith"?
Lastly, is there some place you could point me to that would be able to assist me in finding an attorney that deals specifically with these types of issues? Forgive me please if I have violated the forums rules with that such a question .. or even for posting that link... I'm not real familiar with this forum.. yet : )
[COLOR=#000000]Thanks so much for your reply and also the clarification on "Group One".. when I looked it up I could see immediately it was not the type of resources I was looking for.
HouTx, BSN, MSN, EdD
9,051 Posts
I think that PPs may be confusing Safe Harbor protections with governmental protections for Whistle Blowers. Safe Harbor is strictly limited to nursing practice issues & must be invoked at the onset of an assignment. The 'short form' must be followed with submission of the 'long form'. All SH incidents must be reviewed by the organization's Peer Review Committee. If Peer Review is not being administered properly, the Nurse Leader (DON, CNE, CNO, etc) is in violation of the Nurse Practice act... specifically, "unprofessional conduct" and her/his license could be in jeopardy. So, if any Tx nurse believes that these mandatory functions (Peer Review & Safe Harbor) are not being managed according to the law - this needs to be reported to the BON. This would take courage, because the 'reporter' would not be covered by any Whistleblower protections - which are specifically connected to compliance with Federal/State regulations, not BON.
Texas mandated Peer Review because we are the ONLY state with a legally defined Nurse-Patient duty (since 1984). As a result of that legislation, the BON's mandate for monitoring individual practice increased dramatically -- but of course, no additional resources were forthcoming to manage all the extra work. So, Tx created a process whereby the Peer Review process would begin at the local/employer level & only 'serious' issues would be taken on to the BON level. It works very well if an organization manages it correctly. I believe that Kansas also has mandated Peer Review now... so that makes 2 states.
I also want to point out that Safe Harbor protection is not just for bedside nurses. It can be applied whenever a nurse is asked to do something that s/he believes is contrary to out NPA. For instance, if a nurse educator is asked to train non-nurses to perform a nursing-only task, he could declare Safe Harbor so that the issue could be formally reviewed. All of us need to be very familiar with our NPAs - especially as they relate to our everyday work.