Yes___ No_ Comprehensive Request Form Yes___ No_ 3. But, later the nursing management staff discusses a new assignment with me and I accept/agree with the new … Safe Harbor Protocol … safe habour comprehensive request for nursing safe harbor peer review (shpr) only section i (pages 3-6) must becompleted by the nurse when initially invoking safe harbor A nurse’s request for Safe Harbor Must be in Writing, however, use of this form is not required for a nurse to invoke Safe Harbor. If, for example, I believe in good faith that I cannot accept an assignment one day at work because I feel my patients will be placed at risk for unjustifiable harm & then I request safe harbor. Then around 12:30 the med aide arrives and the R.N. I'm a new nurse, I've been working dayshift med/surg for about 8 months now and I remember hearing about safe harbor during nursing school but this is my first actual … 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. Safe Harbor for All; Evaluation Reports – Safe Harbor; MDH's Evaluation of the Minnesota's Response to Sex Trafficking During Super Bowl LII (PDF) Ramsey County Attorney's Office and the Sexual Violence Justice Institute at the Minnesota Coalition Against Sexual Assault. See also the Adoption … Safe Harbor, two words nurses use to protect themselves and the safety of their patients during times of unfavorable working condition. Texas Board of Nursing (TBON, n.d.a) clarifies Safe Harbor as a nursing peer review process the nurse may initiate, under good faith, when asked to engage in assignments or conduct the … Texas Administrative Code (TAC) Title 40, Part 1, Chapter 19, Subchapters G and T, Rule … Nurse made request on: Quick Request Form Yes___ No_ If yes, did nurse complete Comprehensive Request Form before leaving work at end of work period? See revised rules 217.19 (Incident-Based Nursing Peer Review and Whistleblower Protections) and 217.20 (Safe Harbor Peer Review and Whistleblower The Texas Board of Nursing (BON) implemented Safe Harbor for nurses to have a formal procedure to object to an unsafe situation in the workplace. We had a nurse invoke safe harbor the other day because we started the shift with 9 patients per nurse (our usual ratio is 7:1) due to unexpected understaffing. State Reporting and Investigation Requirements/Safe Harbor and ANE: Reporting an instance of ANE in a Nursing Facility is required by both the Texas nursing facility licensing regulations and the Texas Board of Nursing Rules and Regulations. (2017). The nurse’s duty is always to the patient! SAFE HARBOR NURSING PEER REVIEW ACTIVITY SHEET 1. 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. A nurse who intends to invoke safe harbor shall invoke it before the nurse engages in conduct or an assignment giving rise to the nurse's request for safe harbor. c “PLAN SPONSOR:” Type or print the name of your firm. Date and time of request for safe harbor: 2. retracts "safe Harbor" . Invoking safe harbor in accordance with rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer. The idea behind safe harbor is to protect the nurses' license and force the facility to deal with the BON regarding nurse:patient ratios. B. The BON (2013) refers to the duty of a nurse “always advocate for patient safety, including any nursing action necessary to comply with … patient(s). A nurse may also invoke safe harbor at any time during the work period, when an initial assignment changes and, in the nurse's good faith judgment, the … Page 1of 2 10/17 INSTRUCTIONS FOR COMPLETING THE SAFE HARBOR NOTICE STEP 1. PAGE 1 OF THE SAFE HARBOR NOTICE c “FROM:” Type or print the name of your Plan, as found on line 1(a) Name of Employer Plan in the Adoption Agreement.

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