Safe Harbor

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Specializes in icu, er, transplant, case management, ps.

I just finished reading a newspaper article about three ICU nurses, in Texas, who were fired for refusing to take on three patients. One of the nurse's complained that she was assigned a fresh CABG, that was located some distance from her other two critically ill patients. The other two nurses had similar complaints. Perhaps someone from Dallas can give us all some more information. Texas has a portion of their law called Safe Harbor. And nurse who feels she is assigned an unreasonable, unsafe number of patients can put her objections in writing and it will be reviewed, I believe by the Texas BON. But the nurse must continue to work in what she considers an unsafe patient environment until the review is done and a report issued. I may be a bit dense but how does this protect both the nurse and the patients she is responsible for?

It has been years since I worked in ICU and I was assigned to a room, that held four patients. Frequently I was the only nurse assigned to that room. My patients were on vent, multiple IVs, fresh post ops in critical condition, car accident survivors. And if I was assigned to the end room, I was responsible for one of the two dialysis patients receiving dialysis. It was a mad house and the two years I did it, I was fortunate that no patient die because I was the only nurse assigned to the room.

Is this the way that state nursing boards protect their nurses? It looks to me as if they are protecting the employer. And they certainly are not protecting the patient. Last July, when I spent twenty-one days in ICU, I was fortunate to have one nurse assigned to me from 7AM to 7PM. And from 7PM to 7AM, I share my nurse with another patient. I never felt that my life was placed in any danger but if I had been one of those three Texas patients, not only would I have been in danger but so wouldn't have been my nurse. I thought that staffing in ICU was suppose to be 2:1. Not 3:1 or 4:1. Is this par for the course, these days?

Woody:balloons:

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Is this the way that state nursing boards protect their nurses? It looks to me as if they are protecting the employer. And they certainly are not protecting the patient. Last July, when I spent twenty-one days in ICU, I was fortunate to have one nurse assigned to me from 7AM to 7PM. And from 7PM to 7AM, I share my nurse with another patient. I never felt that my life was placed in any danger but if I had been one of those three Texas patients, not only would I have been in danger but so wouldn't have been my nurse. I thought that staffing in ICU was suppose to be 2:1. Not 3:1 or 4:1. Is this par for the course, these days?

Woody:balloons:

WOODY, State Boards of Nursing, have NO, I repeat,NO INTEREST, in PROTECTING NURSES......it is NOT their job.....they protect the public FROM us.....they are NOT our friends.....

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Woody, I believe that if the BON finds in your favor and something had happened to the pt during this time, you would not be held liable as long as deliberate misaction was not in play.

Morte, how negative can you possibly get? Yes, BONs protect the public but that also means protecting the public from assinine decisions like the one Woody described.

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Specializes in Med-Surg/Tele, ER.

It was my understanding that ratio is typically 2:1 in ICU, but I'm sure it depends a lot on facility and state. I know our (superhero) ICU nurses balk at the idea of 3:1, understandably.

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Specializes in Emergency/Trauma/Education.
Woody, I believe that if the BON finds in your favor and something had happened to the pt during this time, you would not be held liable as long as deliberate misaction was not in play.

Morte, how negative can you possibly get? Yes, BONs protect the public but that also means protecting the public from assinine decisions like the one Woody described.

From the Board: "which provides protection for nurses who have been asked to engage in conduct which the nurse in good faith believes would violate the nurse's duty to a patient." It goes on to give the statutory definition of "duty".

Your license is protected, but I'm not sure it would relieve you of any potential civil liability.

Our (Texas) Nurse Practice Act was recently reviewed and revised. Peer Review & Safe Harbor was one of the hot areas that was addressed.

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Specializes in icu, er, transplant, case management, ps.
Woody, I believe that if the BON finds in your favor and something had happened to the pt during this time, you would not be held liable as long as deliberate misaction was not in play.

Morte, how negative can you possibly get? Yes, BONs protect the public but that also means protecting the public from assinine decisions like the one Woody described.

I'm not sure what you mean by your first comment. Am I understanding you correctly that when a nurse files a notice with the BON, something happens to the patient and the BON finds you were put into an unsafe situation, you are not responsible for what happens to the patient? I have done some expert witness testimony and I can see lawyers tearing a new one for the nurse. It was my understanding that the nurse can file a written complaint but she must continue to work in suspect conditions until the Board rules in her favor. To me, that protects neither the nurse or the patient.

An attorney can bring a lawsuit based on the fact that the nurse was aware of the unsafe condition and continued to work any way. And I can see juries awarding damages against the nurse and the hospital. To me, the Texas is paying lip service to the nurses, without really protecting them or the patients. Am I wrong?

Woody:balloons:

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Specializes in Hospital Education Coordinator.

Safe Harbor prevents the nurse from retribution in case of any negative events while caring for the patient. Protects the RN/LVN license. Leaving a group of patients does not make things better for the patients or the remaining nurses. The unit is even more short staffed. The idea behind safe harbor is to protect the nurses' license and force the facility to deal with the BON regarding nurse:patient ratios. Texas does not believe that there is a magic one number fits all but has mandated that patient acuity be considered as well as staff mix and the facility is responsible for safe practice. So if the facility gets safe harbor filed against them they have to answer to the State. It would not be safe though for the nurses to abandon patients just to prove a point. The ideal would be to have the ability to predict acuity on each and every patient for the entire shift--------not likely.

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As a TX nurse who has requested Safe Harbour, my understanding is that the only thing it does is protect your license. If something bad happens to a patient under your care when you've filled out a Safe Harbour form, then your license is protected. The hospital can still fire you and you can still be sued by the patient/patient family.

However, I believe there was recently a ruling that said a nurse cannot be fired simply for requesting a safe harbour form if she does so in good faith. And supposedly a new law is being passed that a nurse cannot be fired for refusing to do something that might result in a sentinel event, again as long as she does it in good faith.

When I requested safe harbour, everyone freaked out and then changed my assignment, rather than having me fill out a safe harbour form.

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Specializes in Emergency/Trauma/Education.
As a TX nurse who has requested Safe Harbour, my understanding is that the only thing it does is protect your license. If something bad happens to a patient under your care when you've filled out a Safe Harbour form, then your license is protected. The hospital can still fire you and you can still be sued by the patient/patient family.

However, I believe there was recently a ruling that said a nurse cannot be fired simply for requesting a safe harbour form if she does so in good faith. And supposedly a new law is being passed that a nurse cannot be fired for refusing to do something that might result in a sentinel event, again as long as she does it in good faith.

When I requested safe harbour, everyone freaked out and then changed my assignment, rather than having me fill out a safe harbour form.

Good explanation!

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Morte, how negative can you possibly get? Yes, BONs protect the public but that also means protecting the public from assinine decisions like the one Woody described.

the truth remains

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The first and most important part to this story, which happened in a hospital very close to me, is that the nurses did NOT file safe harbor.....they refused the assignment, based on the acuity and number. Although I agree with these nurses that their assignments seemed unsafe, from the stories I've seen and heard on the news and in the paper, they didn't go about handling this situation in a professional matter....in fact, it was reported that they went into the neighborhood surrounding the hospital to gather folks for a press conference they held and to carry signs when they petitioned the hospital.

I work in a NICU in the area, and you know what, I wish I could say that I never had to have an assignment that was too heavy.....the reality is that especially in an ICU environment, numbers and acuities change in seconds...and they aren't always ideal.

Jamie

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I work in a NICU in the area, and you know what, I wish I could say that I never had to have an assignment that was too heavy.....the reality is that especially in an ICU environment, numbers and acuities change in seconds...and they aren't always ideal.

Jamie

aren't always ideal?

well, you know what?

it's not acceptable for cc nurses to be overloaded w/critically ill pts.

it's great that a license can be protected.

but what about the patients?

any overload can and will cost them their lives.

no compromise here.

leslie

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