well woody here it is from down under / texas/ me - my voice - we got alote of problems here in texas - we are not unionized we are all for big buisness/ big corps. the nurse is hardly heard - our nursing association hardly does anything and will say when you call them the most they can do is refer you to a lawyer ( yeh right at 400 dollars an hour to protect us from and for doing our duty) . it is crazy.
here is my take and how i use it - if you give me an assignment and it is unsafe and we have a team of nurses or prns or an in house pool of staffing - i will refuse and give my reason if you insist i take the assignment i might call your (the suppervisor) higher up and tell them and give my reason - if after this and maybe one more higher up i might call safe harbor or reevaluate what has been told to me things i might not know - some one is coming in 10 minutes, someone is comeing late, 2 of my patients are being discharged and super is coming to help - whatever.... but if I am forced to take an assignment and i don't want to abandon my shift because i got report and it has stated ( because remember if the shift has not started and you did not get report yet as far as i have been educated you would not be abandoning your shift if you refuse an assignment then). But if somehow i was not as clever as the assigner and got into the shift and report and the acuity etc.... was bad and no one helped me i would call safe harbor - do my best and hoped no one died and probably being the person i am even document "safe harbor" in every patient chart.
see in texas it is a right to work state( yeh right to fire state) and you can be let go for no reason and so many incident reports and safe harbor calls are not reviewed ( I know i had one last year when the RN called the super and no call back was recieved in 15 minutes but she left and it was only me and her and i was l left alone , no training or experience on the equiment and proceedure we had for this phone system which i was handling for a 1500 bed hospital to call a code and teams and the entire night the super never called back and no other hierarchial person was in place and no numbers available for our department and we were told we could not call the main hospital supervisors due to we were the call center - but the next day after that night when i emailed several persons without response and i included my safe harbor call i was told our department did not have safe harbor by the director herself so i took it to the next hirer up and never heard again about it and i do know that our big hospital does say they investigate safe harbor calls when the BON and others ask and state they have policy in place) so long story short it is a mess in texas and staffing sucks and nurses are treated like factory workers and even RN's treated as disposable tissue with no voice or recourse ( unless you can sue and that is if you have clout to go against a dr, hospital and judges who know these dr, hospitals, etc).
well i have since been fired and an eeoc claim is under way and i hear that that department i once was in has had 2 investigations about calling codes and patients dieing.....should they not have heard my cry and fixed problems???????????????????
So whether fired for just refusing an assignment i think is what part of the process of refusing and getting report but calling safe harbor is safe harbor at any time and any place you have an RN.... i just know i have a right to voice my opinion and i must tell someone it is unsafe before calling safe harbor and i start with my refusal of the assignment - so be it if i am really fired for insubordinate or just fired - this is logically how i kept it straight and as a nurse i am not shy or sly or coey - you who ever you are must know i think the assignment is so unsafe i don't want it and need help and not to be confused with "i think it is unsafe..." so i refuse and a super can then tell me i have to take it and then the ball is in their court and that is straight communication, to me and i hope to a court and all else.
hope this helps - god help us nurses we have duty but no one knows our duty, we have a course of action but no recourse, we have legislation like whistle blowers protection but law enforcing the protection.... Pray woody just pray alote and keep a clean innocent non ego for your patient attitude at all times. ( but by gosh take care of your self and smell the wind for bad supers, bad staffing, mis labled patients ( i mean a real icu patient put on a med surg floor, a hospital discharged patient coming back to a step down unit that should have never left the hospital.... got to caught stuff early or then you get really caught up in the mess and safe harbor will hopefully protect you if you have a good lawyer).