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?
Do you really think that a fine the Texas BON might impose on a hospital is going to make it mend it's ways?
Probably not ... but then, I don't think this necessarily equates with the BON protecting the hospital.
I once warned our CEO that we were in danger of being fined five million dollars by the state of New York, for inappropriate admissions, some lasting ten years. He laughed and told me that the BOH would fine us, we were owned, operated and funded by the Department of Education, NYS. We were fined the five million and it was taken right out of our operating budget. There was hell to pay, trying to find ways to replace that five million dollars.
I'm not sure I understand this. I'm not trying to be difficult, but I'm really not understanding this story. I'm sorry.
Specializes in icu, er, transplant, case management, ps.
Probably not ... but then, I don't think this necessarily equates with the BON protecting the hospital.
I'm not sure I understand this. I'm not trying to be difficult, but I'm really not understanding this story. I'm sorry.
The hospitals in Texas apparently feel they can get away with short staffing, risking only fines. Fines are worked into a hospitals operating budget. They are considered a cost of operating the facility. Until a facility is hit with a big fine. Then heads role. It took a five million dollar fine to get the head of my hospital's attention. It will more then likely take a big size fine to get a Texas hospital's attention as well.
Safe Harbor is merely a means that a nurse can officially express his/her concerns about staffing. It does not fix the staffing. The forms are long and take forever to fill out. It is a whole packet that usually is around an inch thick. Places I have worked in management made Safe Harbor a joke. When it was discussed in our admin meetings, some of the admin staff would actually say things like "Oh let them yell Safe Harbor. Give them the packet. Once they see how bad it is to fill out they'll quit griping about it and get back to work." In most places, if a nurse fills out Safe Harbor, they become marked. They are watched. They are gotten rid of if possible. The best defense for a nurse is to keep a daily work log of staffing, problems that day, interactions with management, etc. That way they can pull out their book when they are threatened by management or a lawsuit and have documentation backing them up. Safe Harbor is not all it's cracked up to be. A few hospitals might be afraid of it, but that is the exception and not the rule.
The nurses in Dallas were fired because the hospital needed them out of the way. The staff had become involved in union activities. The hospital was so scared that they held several mandatory meetings to teach the directors what is and is not legal when trying to break up people who talk about unions. The directors were taught how to talk their staff out of union activities legally. The hospital went to a mandatory uniform code to prevent union activity. Some of the nurses had worn shirts that had union type logos on them to work. Because it is illegal to reprimand the staff and ban those shirts, this hospital made EVERYONE go to a uniform color of the hospital's choosing to prevent those staff from wearing their union scrubs. Because the hospital did this, they bought 3 uniforms plus a scrub jacket for all their full time people. Do you realize how much money that cost them? All to prevent union advertising on scrubs. Those nurses were sacrificed by the hospital to prevent them from infecting the other staff. Yes, those nurses tried to get a petition started as well as a protest. It was small. But in the end I have not seen that it did anything. This hospital has been in management turmoil and has a bad reputation in the community for patient care. At this point they will do anything to control the damage.
Is this the way that state nursing boards protect their nurses? It looks to me as if they are protecting the employer.
Woody:balloons:
Why is it that so many nurses think the state boards are here to protect nurses? This is not there purpose. They are here to protect the public from poor nursing practice.
I was in a situation to file safe harbor and basically what it is.....a 14 page form that the nurse initates, it does not go to peer review, each higher level of management up to nursing director has to investigate and fill out that form. Print it up on the bon website to see. They have so many days to get it done and they have to notify the nurse of thier findings. Face it, we all get placed in unsafe situations. Safe Harbor is there to protect the nurse in the likely event that something bad happens on the shift related to that. If the event is reported to the state board then that nurses license is not in danger. When I told the house supervisor that I was filing safe harbor, I immediately (within 10 minutes) had the don on my floor talking to me. She said "well unfortunenately we don't have the staff to send you" I said "well unfortunately I am filing safe harbor." within 30 minutes I had managers from all over the place coming to help on the floor. They don't want to have to explain why one of thier nurses felt the place was unsafe. Look at it this way.....you have 28 pts with 4 nurses and 1 charge and no pca. One nurse leaves sick and staffing tells you they have no one else.....hmmmm ok well this is definately a safe harbor thing. THat way at least you are protected with your hard earned license in case a pt falls, codes while there is noone rounding because you have 10 pts ect ect
I was in a situation to file safe harbor and basically what it is.....a 14 page form that the nurse initates, it does not go to peer review, each higher level of management up to nursing director has to investigate and fill out that form. Print it up on the bon website to see. They have so many days to get it done and they have to notify the nurse of thier findings. Face it, we all get placed in unsafe situations. Safe Harbor is there to protect the nurse in the likely event that something bad happens on the shift related to that. If the event is reported to the state board then that nurses license is not in danger. When I told the house supervisor that I was filing safe harbor, I immediately (within 10 minutes) had the don on my floor talking to me. She said "well unfortunenately we don't have the staff to send you" I said "well unfortunately I am filing safe harbor." within 30 minutes I had managers from all over the place coming to help on the floor. They don't want to have to explain why one of thier nurses felt the place was unsafe. Look at it this way.....you have 28 pts with 4 nurses and 1 charge and no pca. One nurse leaves sick and staffing tells you they have no one else.....hmmmm ok well this is definately a safe harbor thing. THat way at least you are protected with your hard earned license in case a pt falls, codes while there is noone rounding because you have 10 pts ect ect
Could you keep us informed if there are any reta;iation for this? Everyone I have known to even threaten safe harbor was let go-longest was 3 months.
I do applaud you for your actions because it takes guts to do what you did. I am hoping things may have changed, so invoking safe harbor can take place to push hospitals into providing safe care to the patients.
Could you keep us informed if there are any reta;iation for this? Everyone I have known to even threaten safe harbor was let go-longest was 3 months.
I do applaud you for your actions because it takes guts to do what you did. I am hoping things may have changed, so invoking safe harbor can take place to push hospitals into providing safe care to the patients.
This was about 41/2 yrs ago. I just recently got terminated from there but it wasn't because of that. It was other politics. Experienced nurses have to be careful because management wants to get the newer nurses in who don't know that they are getting ran over and are more likely to say ok to whatever situation they are placed in. Nothing bad on new nurses as I was one once, but the less experience the more likely they will try to run you over so now they replace them.
While the form itself really only protects a nurse and doesn't do much for patient safety (which sucks) in hospitals where the use of Safe Harbour is closely monitored and investigated, a lot of units make the necessary accomodations to prevent the form from being utilized in the first place ... so that process, in a way, does help improve patient safety.
Most definately. In orientation today, we were told by a nurse educator that we were still held responsible even if we invoked safe harbour. This is true, we must be held responsible... but if the problem is found to be systemic or out of our control, then the blame will not be put on us.
It seems that if you DONT invoke safe harbour - then technically, you can't really state later that you felt your assignment was unsafe. Then the educator went on to say that it was MOUNDS of paper work. (at the end of the shift). 14 pages isn't even as long as 1 care plan I had to do in school!
So, she then repeated the point that they definitely want us to go through the channels, like the Charge Nurse, Unit Manager, Director, OA -before we have try to invoke safe harbour. How exactly are you supposed to do that when your super busy? Dunno. But hopefully you'd only have to speak to 1 or two people to get changes IMMEDIATELY, and protect our patients!
Why is it that so many nurses think the state boards are here to protect nurses? This is not there purpose. They are here to protect the public from poor nursing practice.
Yeah, it's too bad they don't protect the patients from hospital administration.
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).
yeh yeh they all - ie the law and policy says they will not fire but how many end up fired and and retaliated against for calling safe harbor and still have their job and promotions in 10 years???? get real other texas nurse - where is the law and action that supports a whistle blower? tell me where??????
who helps???????
talk some now about Group one in texas that is a hospital reporting agency about nurses that no longer work for you and is like a credit buero bank about not for nurses and could hold lies and take years to fix and the nursing board here in texas says you have to get a lawyer to fight them....?????
Susan9608
205 Posts
Probably not ... but then, I don't think this necessarily equates with the BON protecting the hospital.
I'm not sure I understand this. I'm not trying to be difficult, but I'm really not understanding this story. I'm sorry.