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Safe Harbor when to evoke it?

Posted

Maybe you all can shed some light on this subject? Situation:

A R.N. is scheduled to work double week-ends at a Nursing Home. She is informed that her Certified Medication Aide has a flat and is about an hour away and has to wait for the auto club to come to assist. It is now 7 am and your medication pass begins at 7:30. What would a Prudent Nurse do?

Time now is 10:30 and you just begin your med pass. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it.

Then around 12:30 the med aide arrives and the R.N. retracts "safe Harbor" .

The med aid reports upon her arrival the med pass from the morning was not finished.

The DON attempted to contact the R.N. regarding disciplanary action for failure to administer medications as a Prudent Nurse would do, and for potentially causing harm to the Resident's for not receiving their medications.

The R.N. refused to come to the facility and now claims that she is exempt from any actions due to "Safe Harbor" and that she is protected from being fired.

Is "safe harbor" appropiate in this case? What would a Prudent Nurse do? Should the Nurse be disciplined or even fired?

Everyones feedback is greatly appreciated!!!!!!!

Safe Harbor means protection for a nurse who refuses to perform an activity that could be reportable to a BON. This could be refusing an employers directive, or engaging in conduct against rules. It cannot be used to justify not doing your job

I am not sure if this nurse worked NOCs and stayed later or if this was a day shift nurse who was performing other duties while waiting for the med aide? I f this was a day nurse, I would say that in a nursing home, meds take precedence over administrative tasks and even assessments (unless of course a resident experienced a change of condition that warranted immediate attention). It is ultimately the nurses responsibility and it seems that safe harbor would not apply.

I am also wondering how the situation is unsafe without a medication aide? Is the nurse also passing meds? Is she supervising 100 patients? If this is the case, what happens when the med aide is ill?

Just saying "Safe Harbor" doesn't necessarily exempt a nurse from disciplinary action. There should be a peer review. The nurse wasn't asked to go against any rules or engage in inappropriate conduct. However if this was a NOC nurse who stayed to help out and is now being disciplined, that's a whole other story. It becomes the job of shift supervisors, DON, etc to find a replacement for the RN.

Are you the DON in this story or the RN? Either way, you should look up your state's process and definition of safe harbor.

Kalico

Specializes in NICN. Has 1 years experience.

Safe Harbor means protection for a nurse who refuses to perform an activity that could be reportable to a BON. This could be refusing an employers directive, or engaging in conduct against rules. It cannot be used to justify not doing your job

I am not sure if this nurse worked NOCs and stayed later or if this was a day shift nurse who was performing other duties while waiting for the med aide? I f this was a day nurse, I would say that in a nursing home, meds take precedence over administrative tasks and even assessments (unless of course a resident experienced a change of condition that warranted immediate attention). It is ultimately the nurses responsibility and it seems that safe harbor would not apply.

I am also wondering how the situation is unsafe without a medication aide? Is the nurse also passing meds? Is she supervising 100 patients? If this is the case, what happens when the med aide is ill?

Just saying "Safe Harbor" doesn't necessarily exempt a nurse from disciplinary action. There should be a peer review. The nurse wasn't asked to go against any rules or engage in inappropriate conduct. However if this was a NOC nurse who stayed to help out and is now being disciplined, that's a whole other story. It becomes the job of shift supervisors, DON, etc to find a replacement for the RN.

Are you the DON in this story or the RN? Either way, you should look up your state's process and definition of safe harbor.

I'm just a student so maybe that is why I don't know this, but what is NOC?

begalli

Specializes in Critical Care/ICU.

NOC = night shift, usually 11pm-7am.

btw, it's short for nocturnal.

Kalico

Specializes in NICN. Has 1 years experience.

NOC = night shift, usually 11pm-7am.

btw, it's short for nocturnal.

I thought so but there have been some abbreviations that turn out to be acronyms. Thanks:)

Safe Harbor means protection for a nurse who refuses to perform an activity that could be reportable to a BON. This could be refusing an employers directive, or engaging in conduct against rules. It cannot be used to justify not doing your job

I am not sure if this nurse worked NOCs and stayed later or if this was a day shift nurse who was performing other duties while waiting for the med aide? I f this was a day nurse, I would say that in a nursing home, meds take precedence over administrative tasks and even assessments (unless of course a resident experienced a change of condition that warranted immediate attention). It is ultimately the nurses responsibility and it seems that safe harbor would not apply.

I am also wondering how the situation is unsafe without a medication aide? Is the nurse also passing meds? Is she supervising 100 patients? If this is the case, what happens when the med aide is ill?

Just saying "Safe Harbor" doesn't necessarily exempt a nurse from disciplinary action. There should be a peer review. The nurse wasn't asked to go against any rules or engage in inappropriate conduct. However if this was a NOC nurse who stayed to help out and is now being disciplined, that's a whole other story. It becomes the job of shift supervisors, DON, etc to find a replacement for the RN.

Are you the DON in this story or the RN? Either way, you should look up your state's process and definition of safe harbor.

Bagernurse,

Thanks for responding. I am the DON in this story and at my wits end! The R.N. works double week-ends 6am-10pm sat&sun on the Baylor plan (32for40)

I did review "safe harbor" and your response was my interpretation as well. I tried to expain that to no avail the nurse insist otherwise. She did retract her claim once the med aide arrived. When I discovered no attempts were made to administer meds until 3 hours after they were due I freaked! I have 2 Nurses on the w/e they have about 20-25 pts each. Neither one started the pass until 3 hrs after they were due. I diciplined the LVN and the RN refused to come to the facility and said she would see me sat if need be and that she is exempt from any med errors etc. because i created an unsafe work condition by not having a med aide. She also indicated that doing doubles made her unsafe to pass meds because she doesnt get much sleep in between. But she is comfortable delegating medication administration to a med who works the same hours. Not to mention the insubordination by refusing to come in and discuss these serious concerns. Its always difficult to fire anyone due to Administration barring you d/t unemployment claims however, I am willing to take the heat if justifiable. Thats why i need all the input i can get. I really am not comfortable with this nurse caring for my Resident's now and am prepared to work the floor myself. Tomorrow's fri.UGH.

mommatrauma, RN

Specializes in ER.

Bagernurse,

Thanks for responding. I am the DON in this story and at my wits end! The R.N. works double week-ends 6am-10pm sat&sun on the Baylor plan (32for40)

I did review "safe harbor" and your response was my interpretation as well. I tried to expain that to no avail the nurse insist otherwise. She did retract her claim once the med aide arrived. When I discovered no attempts were made to administer meds until 3 hours after they were due I freaked! I have 2 Nurses on the w/e they have about 20-25 pts each. Neither one started the pass until 3 hrs after they were due. I diciplined the LVN and the RN refused to come to the facility and said she would see me sat if need be and that she is exempt from any med errors etc. because i created an unsafe work condition by not having a med aide. She also indicated that doing doubles made her unsafe to pass meds because she doesnt get much sleep in between. But she is comfortable delegating medication administration to a med who works the same hours. Not to mention the insubordination by refusing to come in and discuss these serious concerns. Its always difficult to fire anyone due to Administration barring you d/t unemployment claims however, I am willing to take the heat if justifiable. Thats why i need all the input i can get. I really am not comfortable with this nurse caring for my Resident's now and am prepared to work the floor myself. Tomorrow's fri.UGH.

Sounds negligent to me, not to mention extremely lazy...and the fact that she refused to come to the hospital for discipline...well that's a whole other issue...I'd say, hmmm..don't worry about seeing me Sat...because you won't be working until we can sort all of this out...maybe then she'll realize how serious the consequences could be...Also sounds like she is the one that made the situation unsafe by not picking up the slack and taking care of the patients...Did someone hold a gun to her head and tell her she had to work the weekend program?? I'm guessing probably no...which then leads me to believe she was well aware of what type of hours she'd be working in advance of taking this job...and it sounds like she has no trouble working her doubles on the other weekends when she doesn't have to strain herself...People like this give nursing a bad name...Even if she felt her situation was not safe, she still dropped the ball on top of that...and now is trying to hide behind something that doesn't even apply to the situation...ultimately, she is responsible for the patient...its her license...I think you have no choice but to take disciplinary action...simply for the protection of the patients...

PMHNP10

Has 6 years experience.

Maybe you all can shed some light on this subject? Situation:

A R.N. is scheduled to work double week-ends at a Nursing Home. She is informed that her Certified Medication Aide has a flat and is about an hour away and has to wait for the auto club to come to assist. It is now 7 am and your medication pass begins at 7:30. What would a Prudent Nurse do?

Time now is 10:30 and you just begin your med pass. You notify the DON around 11:30 and evoke "safe harbor" expaining that the situation is unsafe because you dont have a med aide, even though passing meds is the reponsibility of the Nurse, whether she/he does it or deligates it.

Then around 12:30 the med aide arrives and the R.N. retracts "safe Harbor" .

The med aid reports upon her arrival the med pass from the morning was not finished.

The DON attempted to contact the R.N. regarding disciplanary action for failure to administer medications as a Prudent Nurse would do, and for potentially causing harm to the Resident's for not receiving their medications.

The R.N. refused to come to the facility and now claims that she is exempt from any actions due to "Safe Harbor" and that she is protected from being fired.

Is "safe harbor" appropiate in this case? What would a Prudent Nurse do? Should the Nurse be disciplined or even fired?

Everyones feedback is greatly appreciated!!!!!!!

There are 2 uses of safe Harbor:

One is when questioning the "medical reasonableness of a physician's order".

The other use of safe harbor is when you believe that an assignment does not allow you to perform your duties to patients; then by envoking safe harbor in good faith you protect your license from the TX BON in case an unfortunate event occurs. You can agree or disagree, but being responsible for 20+ pts at a nursing home is unsafe, multiply that when you are short staffed. Therefore, from what you posted, her use of the safe harbor seems appropriate.

Also remember that a nurse has the right/duty to refuse an assignemnt if the nurse believes they are unable to physically/emotionally perform a duty for a patient. As long as the nurse notifies the supervisor as to why the assignment is being refused, the nurse can avoid action from the BON. However, the TX BNE doesn't ensure that the nurse can't be disciplined by the employer since they have made it very known that they don't get involved in "employment issues". And in turn, if the employee were terminated for refusing an assignment, then they could have civil recourse.

As the nurse, if you invoke safe harbor you have the right to accept the assignment or not (if you have notified the supervisor of your concerns and filled out the appropriate paperwork).

A few things crossed my mind while reading the OP several times. Therefore, I'm not quite ready to call the RN "lazy" or "negligent" because I'm not quite aware of the whole story.

My first question is why would it take 4.5 hrs to get a flat fixed (I figure 4.5 hrs because it took the aide 5.5 hrs to get to work from what I believe is the time of call-in which I'm interpreting from your post as being done at around 7 am? Point being, 4.5 hrs seems like an extended period of time.

When did the medication aide say she'd be at work, if ever? Perhaps the understanding was that the aide was to get in at 830 or so and so it seems reasonable to not start the med pass if the aide is going to be there soon. What are the duties of the RN? One poster mentioned that meds were more important than even assessments. I can't agree with that. I could not give a medication without doing an assessment first, which is exactly why med aides are dangerous, but that's a different thread. I do agree any administrative work is of little/no priority. What did the RN spend the 3 hrs doing? Was she sitting around pissing and moaning about having to do her job or was she assessing her patients?

The RN is correct in that she can't be held responsible for med errors because of the safe harbor; however, like I said, she is not exempt from employer disciplinary action. Certainly her insubordinance would be grounds for termination.

Can someone explain the concept of Safe Harbor has it applies to nursing? I'm still a student and did not realize that there was a "safe harbor" provision recognized in law by various State Boards of Nursing. I would imagine that the concept varies from state to state and is more recognized in some places than others. I have always associated the term with businesses and individuals who attempt to comply with complicated federal and state laws. Safe Harbor meaning that even if a business fails to comply with the letter of the law it will be given the benefit of the doubt if it is acting "in the spirit" or in good faith with the law.

Sounds negligent to me, not to mention extremely lazy...and the fact that she refused to come to the hospital for discipline...well that's a whole other issue...I'd say, hmmm..don't worry about seeing me Sat...because you won't be working until we can sort all of this out...maybe then she'll realize how serious the consequences could be...Also sounds like she is the one that made the situation unsafe by not picking up the slack and taking care of the patients...Did someone hold a gun to her head and tell her she had to work the weekend program?? I'm guessing probably no...which then leads me to believe she was well aware of what type of hours she'd be working in advance of taking this job...and it sounds like she has no trouble working her doubles on the other weekends when she doesn't have to strain herself...People like this give nursing a bad name...Even if she felt her situation was not safe, she still dropped the ball on top of that...and now is trying to hide behind something that doesn't even apply to the situation...ultimately, she is responsible for the patient...its her license...I think you have no choice but to take disciplinary action...simply for the protection of the patients...

RoxanRN

Specializes in CCRN, CNRN, Flight Nurse. Has 10 years experience.

...that she is exempt from any med errors etc. because i created an unsafe work condition by not having a med aide. She also indicated that doing doubles made her unsafe to pass meds because she doesnt get much sleep in between.
If working double shifts makes she feels unsafe passing meds, then she should feel unsafe in all aspects of her job. Don't the rest of her required tasks require the same amount of sleep/rest?

I do not feel safe harbor is appropriate in this situation. I also do not feel 20 residents in a nursing home is unsafe when you are provided a med aid also. I believe that in the event such as flat tire or illness then the nurse should have prioritized her duties and started the med pass. She was absolutely insubordinate and I can not understand why nurses like her have a job while nurses such as myself are unemployed. GRRRRRRRRRRRR:angryfire

This nurse clearly needs disciplinary action. I would start the meeting with some education on the applications of safe harbor. Also maybe some info on code of conduct too. Can you imaginge the implications if you do not discipline this nurse? She could yell "safe harbor" every time a co worker is late or called in sick. What if she has a patient that needs her attention for an hour? She should not be allowed to work double weekends if you decide to not fire her (which may be justified). She has herself expressed that she is not safe in her job.

This is pretty serious and you're right to not feel comfortable. This nurse has a set of grapes on her for not discussing the concerns. It's too bad you have to be in this position.

txspadequeenRN, BSN, RN

Specializes in ICU, PICC Nurse, Nursing Supervisor. Has 20 years experience.

There is no guarentee of a med-aide on any shift and especially the weekend. Any nurse that does the weekends needs to be prepared to do his/her own meds. In the end that nurse is responsible for thoses meds. Why did she wait so late to start passing them? She did know when she took the job she had 20 patients ( which in a nursing home is a very reasonable load). Times can get very stressfull in nursing homes, but you have to plan ahead. Sounds like to me she just didnt want to pass them. But then really who does, that is the most boring job ever created for nurses.

txspadequeenRN, BSN, RN

Specializes in ICU, PICC Nurse, Nursing Supervisor. Has 20 years experience.

Always follow your gut instinct.....

Bagernurse,

Thanks for responding. I am the DON in this story and at my wits end! The R.N. works double week-ends 6am-10pm sat&sun on the Baylor plan (32for40)

I did review "safe harbor" and your response was my interpretation as well. I tried to expain that to no avail the nurse insist otherwise. She did retract her claim once the med aide arrived. When I discovered no attempts were made to administer meds until 3 hours after they were due I freaked! I have 2 Nurses on the w/e they have about 20-25 pts each. Neither one started the pass until 3 hrs after they were due. I diciplined the LVN and the RN refused to come to the facility and said she would see me sat if need be and that she is exempt from any med errors etc. because i created an unsafe work condition by not having a med aide. She also indicated that doing doubles made her unsafe to pass meds because she doesnt get much sleep in between. But she is comfortable delegating medication administration to a med who works the same hours. Not to mention the insubordination by refusing to come in and discuss these serious concerns. Its always difficult to fire anyone due to Administration barring you d/t unemployment claims however, I am willing to take the heat if justifiable. Thats why i need all the input i can get. I really am not comfortable with this nurse caring for my Resident's now and am prepared to work the floor myself. Tomorrow's fri.UGH.

PMHNP10

Has 6 years experience.

I do not feel safe harbor is appropriate in this situation. I also do not feel 20 residents in a nursing home is unsafe when you are provided a med aid also. I believe that in the event such as flat tire or illness then the nurse should have prioritized her duties and started the med pass. She was absolutely insubordinate and I can not understand why nurses like her have a job while nurses such as myself are unemployed. GRRRRRRRRRRRR:angryfire

Read RN Update published by the TX BON for Jan 2002, and it sounds like safe harbor was appropriate. She notified the sup and filed the paperwork. Really the only question one might have is whether she did so in good faith. Again, I'm not ready to hang the nurse based on one half of the story. It's unfortunate that so many fellow nurse are happy to burn her at the stake. Do we know what was happening on the unit? Were there extenuating circumstances? Do we know what was being communicated from the med aide about time of arrival? Do we know of any other staff present? It's unfortunate that 20 patients for each nurse is considered a safe situation in any setting. Perhaps stats have changed, but if I'm not mistaken, most nurses punished by their BON work in the long term care setting. Yet another reason there is a shortage of nurses willing to work at the bedside.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

I have no experience as an RN in LTC, so I don't pretend to know the ins and outs of staffing. I agree that the nurse should have started the med pass. Apparently the question is whether staffing was truly indadequate and unsafe, or not. If not, then the nurse on duty was out of line, and should be disciplined. If staffing WAS inadequate or unsafe, then why did the supervisor not go in herself when notified of the staffing situation?

I was the nurse manager of a NICU for a few years, and had 24 hour accountability for my unit. It didn't happen often, but on the rare occasions that staffing was inadequate, had no choice but to go in myself. I don't see that this situation is any different.

pooh54

Specializes in Level 2 and 3 NICU, outpt peds. Has 22 years experience.

While I too don't have any eperience in LTC, it would seem that a lack of prioritization is at work here. I would have prioritized medications and assessments around those that absolutely needed to be passed at 0730 ie insulin , dig etc. Rather than calling her lazy, how aboutasking her reasons for not beginning meds and perhaps educating her on prioritization? Sounds pollyanish but as a past manager, I've learned never to assume someone knew how to do this, or knew the full implications of their jobs and responsibilities. BTW, i do appreciate your frustrations! :stone hang in there!

I do not feel safe harbor is appropriate in this situation. I also do not feel 20 residents in a nursing home is unsafe when you are provided a med aid also. I believe that in the event such as flat tire or illness then the nurse should have prioritized her duties and started the med pass. She was absolutely insubordinate and I can not understand why nurses like her have a job while nurses such as myself are unemployed. GRRRRRRRRRRRR:angryfire

:) Ever think of week-end doubles?

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