presenters: judy ho msn, rn, acns- bc,...
TRANSCRIPT
Protect Your Patient, Protect Yourself:
Know Your Nursing Practice Act
April 2010
Presenters: Judy Ho MSN, RN, ACNS- BC, CPHQ
Geraldine Jones MS, RN-BC
ObjectivesObjectives
•
List the primary types of Nursing Peer Review (NPR).
•
Discuss how NPR can create and improve a better work environment
for the nurses.•
Identify the minimum due process
involved in a NPR.
Texas Board of Nursing
•
Mission: to protect and promote the welfare of the people
of Texas by
ensuring that each person holding a license as a nurse in this state is
competent to practice safely.
BON Rules & Regulations
•
Rule 217. 11 Standards of Nursing Practice
•
Rule 217. 12 Unprofessional Conduct•
Rule 219.19 Incident Based Peer
Review and Whistle Blower Protections
Rule 217.12 Unprofessional Practice (1A)
•
Carelessly failing, repeatedly failing, or exhibiting an inability to perform
vocational, registered, or advanced practice nursing in conformity with the standards of minimum acceptable
level of nursing practice set out in Rule 217.11.
Rule 217.12 Unprofessional Practice (1B)
• Carelessly or repeatedly failing to
conform to generally accepted nursing standards in applicable practice
settings;
Rule 217.12 Unprofessional Practice (1D)
•
Delegating or assigning nursing functions or a prescribed health
function when the delegation or assignment could reasonably be expected to result in unsafe or
ineffective client care; Chapter 224: Delegation of Nursing Tasks by Registered Professional
Nurses to Unlicensed Personnel for Clients with Acute Conditions
or in Acute Care Environment
Rule 217.12 Unprofessional Practice (1F)
•
Failing to supervise the performance of tasks by any individual working
pursuant to the nurse’s delegation or assignment
Rule 217.12 Unprofessional Practice (1E)
•
Accepting the assignment of nursing functions or a prescribed health
function when the acceptance of the assignment could be reasonably
expected to result in unsafe or ineffective client care;
Safe Harbor: Request to Determine Medical Reasonableness of a
Physician Order
Rule 217.12 Unprofessional Practice (4)
•
Careless or repetitive conduct that may endanger a clientʹs life, health, or
safety. Actual injury to a client need not be established.
Rule 217.12 Unprofessional Practice (5)
•
Inability to Practice Safely‐ demonstration of actual or potential
inability to practice nursing with reasonable skill and safety to clients by
reason of illness, use of alcohol, drugs, chemicals, or any other mood‐
altering substances, or as a result of any mental or physical condition;
Rule 217.12 Unprofessional Practice (6)
A.
Falsifying reports, client documentation, agency records or
other documents (1C –
Improper management of client records)
B. Failing to cooperate with a lawful
investigation conducted by the board;
Rule 217.12 Unprofessional Practice (6)
C.
Causing or permitting physical, emotional or verbal abuse or injury
or neglect to the client or the public, or failing to report same to the
employer, appropriate legal authority and/or licensing board (6F:
Threatening or violent behavior in the workplace);
Rule 217.12 Unprofessional Practice (6)
D.
Violating professional boundaries of the nurse/client relationship (physical, sexual, emotional or financial
exploitation);E.
Engaging in sexual conduct with a
client, touching a client in a sexual manner, requesting or offering
sexual favors, or language or behavior suggestive of the same;
Rule 217.12 Unprofessional Practice (8)
•
Drug diversion
Rule 217.12 Unprofessional Practice (10)
A.
Use of any controlled substance or any drug, prescribed or
unprescribed, or device or alcoholic beverages while on duty or on call
and to the extent that such use may impair the nurseʹs ability to safely conduct to the public the practice
authorized by the nurseʹs license;
Rule 217.12 Unprofessional Practice (10)
B. Falsification of or making incorrect,
inconsistent, or unintelligible entries in any agency, client, or other record
pertaining to drugs or controlled substances;
C. Failing to follow the policy and procedure
in place for the wastage of medications at the facility where the nurse was employed or working at the time of the incident(s);
Rule 217.12 Unprofessional Practice (10)
D.
A positive drug screen for which there is no lawful prescription; or
E. Obtaining or attempting to obtain or
deliver medication(s) through means of misrepresentation, fraud, forgery,
deception and/or subterfuge.
Rule 217.12 Unprofessional Practice (11)
D.
Failing to report violations of the Nursing Practice Act and/or the
Boardʹs rules and regulations.
Rule 217.12 Unprofessional Practice (12)
•
Leaving a nursing assignment, including a supervisory assignment,
without notifying the appropriate personnel.
Conducts Subject to Reporting (Rule 217.19 Incident –Based Nursing Peer Review & Whistleblower
Protections)
•
Violates the NPA or a Board Rule & contributed to the death or serious
injury of a pt.•
Causes a person to suspect that the
nurse’s practice is impaired by chemical dependency or drug or
alcohol abuse
Conducts Subject to Reporting (Rule 217.19 Incident –Based Nursing Peer Review & Whistleblower
Protections)
•
Constitutes abuse, exploitation, fraud, or a violation of professional
boundaries•
Indicates that the nurse lacks
knowledge, skill, judgment, or consciousness (continued practice
would pose a risk of harm)
What is a Minor Incident?
•
Conduct by a nurse that does not indicate that the nurse’s continued
practice poses a risk of harm to a patient or another person.
•
Minor error•
Minor violation
Peer Review – What is it?
The evaluation of:–
Nursing services
–
The qualification of a nurse–
The quality of patient care rendered by a
nurse–
The merits of a complaint concerning a
nurse or nursing care–
A determination or recommendation
regarding a complaint.
Nature of Nursing Peer Review
• Focused on obtaining relevant
information1.
Fact finding
2.
Analysis and study of events
• Occurs in a climate of collegial
problem solving
What it is NOT !!!What it is NOT !!!
It is not
part of the institution’s corrective
action process !!!
Nursing Peer Review Committee
•
A committee established …. for the purpose of conducting peer review.
Nursing Peer Review Committee Membership
•
Must have nurses as three‐fourths of its members.
• Vocational nursing ‐
must include vocational nurses as members and may have only registered nurses and
vocational nurses as voting members.•
Professional nursing ‐
must have
registered nurses as two‐thirds of its members, and may have only
registered nurses as voting members.
Nursing Peer Review Committee Membership
•
Shall include to the extent feasible at least one nurse who has a working familiarity
with the area of nursing practice in which the nurse being reviewed practices.
•
Exclude from the committee, including attendance at the peer review hearing, any
person or persons with administrative authority for personnel decisions directly
relating to the nurse.
Who must have a peer review plan?
1.
Vocational nurses ‐
if the person regularly employs, hires, or contracts
for the services of 10 or more nurses 2.
Professional nurses ‐
if the person
regularly employs, hires, or contracts for the services of 10 or more nurses,
at least five of whom are RN
What are the different types of NPR?
What are the different types of NPR?
• Incident‐Based Peer Review ‐ includes minor incidents
•Safe Harbor Peer Review
Incident‐Based Peer Review
•
Focuses on determining if a nurseʹs actions, be it a single event or multiple events (such as in reviewing up to five (5) minor
incidents by the same nurse within a yearʹs period of time) should be reported to the
Board, or if the nurseʹs conduct does not require reporting because the conduct
constitutes a minor incident that can be remediated.
Minimum Due Process Rule 217.19 Incident Based NPR & Whistleblower Protections
•
Nursing Peer Review Law – TOC 303.002
•
Written polices and procedures at the conducting facility
•
Level of participation of the nurse or nurse’
representative
•
Confidentiality & safeguards to prevent impermissible disclosures
Minimum Due Process Rule 217.19 Incident Based NPR & Whistleblower Protections
•
The incident‐based peer review committee will meet on a specified
date not sooner than 21 calendar days & not more than 45 calendar days.
•
Inform the nurse ‐
description on the event (s) to be evaluated.
•
Provide the nurse the opportunity to review the documents (at least 15 days prior
to the meeting).
Minimum Due Process Rule 217.19 Incident Based NPR & Whistleblower Protections
•
Provide written notice to the nurse of the committeeʹs findings within 10
calendar fays of when the committee’s review has been completed.
•
Permit the nurse to file a rebuttal statement within 10 calendar days of
the notice of the committee’s findings.
NPR Committee’s Responsibilities
NPR Committee’s Responsibilities
1. Determine whether the Nurse
undergoing the review engaged in reportable conduct or not.
2. Additional recommendation for
the Nurse being reviewed is also included in the report to Board of Nursing (BON).
3. Report to the Chief Nursing
Officer &/or Patient Safety Subcommittee on any related
findings and recommendations that may have an impact on
patient care.
Protect Your Patients!
•
Know your Nursing Practice
Act•
Always advocate
for your patients’ safety – practice
within the standards & report
unprofessional conduct
Protect Yourself!
SAFE HARBOR
•
It’s a State Law ‐Texas Occupation Code 303.005, requires a person
who regularly employs, hires or contracts for the services of at
least ten (10)
nurses to permit a nurse to request Peer Review
SAFE HARBOR
•A process that a nurse can initiate
WHA T?
WHE N?•
When a nurse is requested to engage
on conduct that the she/he
believes
is in violation of his/her duty to a
patient.
SAFE HARBOR SAFE HARBOR RELATED TO RELATED TO
NURSINGNURSING
“Duty To A Patient”
““DUTY TO PATIENTDUTY TO PATIENT””
•Advocate for patient safety
•Avoid engaging in unprofessional conduct
“DUTY TO A PATIENT”
is based on 217.11“All nurses have a duty to maintain a safe
environment for patients/clients and others for who the nurse is responsible.”
ʺDuty to a patientʺ
““PATIENT SAFETY IS THE NURSEPATIENT SAFETY IS THE NURSE’’S HIGHS HIGH
“Unprofessional Conductʺ is based on 217.12 “All nurses have a duty to
maintain a safe environment for patients/clients and others for who the
nurse is responsible.”
“DUTY TO A PATIENT”
•Means a requested conduct, (including administrative and MD decision)
•directly affecting a nurseʹs ability
to comply with that duty, required by standards of practice.
“VIOLATION OF DUTY TO A PA
“Invoke Safe Harbor”
Safe Harbor Relationship to Peer Review
•Standard 217.20 – Safe Harbor
•Part of NPA Standard 217.11 •Part of NPA Standard 217.12•Safe Harbor automatically
initiates a formal investigation by the to NPR committee.
SAFE HARBOR
“A process that protects the nurse
from retaliation
When a nurse makes a good faith request for peer review
That the nurse believes could result in a violation of NPA or Board Rules
SAFE HARBORPROTECTIONS
A nurse who in Good Faith
request Safe Harbor:
••Good FaithGood Faith•action taken is supported by what is reasonable, factual and legal”
•“action doesn’t reflect an intent to harm ( malice)”
•May engage in the requested conduct pending NPR
•Is not reportable to BON if incident occurs during Safe Harbor time frame
•Employer retaliation is prohibited by law
••
BAD FAITHBAD FAITH––
Knowingly and recklessly taking action Knowingly and recklessly taking action
not supported by a reasonable factual or not supported by a reasonable factual or legal basislegal basis
––
Misrepresenting the facts surrounding Misrepresenting the facts surrounding the eventsthe events
––
Acting out of malice, animosityActing out of malice, animosity––
Acting from a conflict of interestActing from a conflict of interest
SAFE HARBORNO!
PROTECTION
•
Invoke Safe Harbor prior to engagement in the conduct
•
Immediately notify supervisor/manager•
Can be invoked at any time during the work
period when the initial assignment changes•
Complete the “Safe Harbor”
Form
–
BON’s
Form–
Institution Form on the Source
•
Signature requirement by staff and supervisor
SAFE HARBOR PROCESS
SAFE HARBOR FORM
•
Informative Process
•
Must be completed by the nurse once Safe Harbor is invoked
•
Includes 6 questions referring to:
1. Description of conduct requested2.
Who made the request3.
Name and title of person initiating the
request4.
Description of practice setting,
responsibilities, and resource
5.
Why duty is violated6.
What changes are necessary
“DUTY TO A PATIENT”
“The nurse’s duty is not defined by any single event such as clocking in or taking report.”
“From a BON standpoint, the focus for disciplinary sanctions is on the relationship and responsibility of
the nurse to the patient, not the employer .”
“Patients are better off with the nurse than without the nurse in the vast majority of cases.”
“WHEN DOES DUTY TO PATIENT
SAFE HARBORMINIMUM DUE PROCESS
The nurse shall be permitted to:•Appear before the NPRC or the
Informal Review Subcommittee (IRS)
•Ask questions and respond to questions of the NPRC
•Make a verbal and/or written statement to explain why he or she
believes the requested conduct would have violated a RN’s duty to a patient to a patient
SAFE HARBOR PROCESS
•
NPR must be completed within 14
days of when the nurse invoked Safe Harbor
•
Within 48
hrs of receiving the NPRC determination the nurse administrator must:
a. Reviews the findings b.
Notify the nurse
c.
Nurse protection ends if NPRC determines SH invoked in bad faith
– Reportable to BON.•
The nurse invoking Safe Harbor shall be
given a copy of the committee determination
SAFE HARBOR
House and Senate Bills 81st
Regular Session of the Texas Legislature
•
House Bill 3961•
House Bill 4354
•
Senate Bill 476•
Senate Bill 1415
Senate Bill 476 Protect the Nurses
•
Nurses working in a hospital may refuse to work mandatory overtime &
refusing to work overtime does not constitute patient abandonment.
•
Requires hospitals to establish nurse staffing committees as standing
committees of the hospital.
Senate Bill 476 Protect the Nurses
• Requires the governing body of a hospital to adopt, implement, and enforce a written official nurse services staffing policy that ensures that an adequate number and skill mix of nurses are available to meet the level of patient care needed.
Senate Bill 476 Protect the Nurses
•
The nurse staffing committee is required to develop and recommend a
nurse staffing plan to the hospital’s governing body.
•
Staffing plans should be used as a component of the nurse staffing
budget & nurses are encouraged to provide input to the committee
without fearing retaliation from their employer.
Questions?
References:
•
Texas Board of Nurse Examiners, retrieved March 16, 2010 from,
http://www.bon.state.tx.us/index.html•
Texas Legislature , retrieved March 16,
2010 from, www.capitol.state.tx.us/•
Texas Board of Nurse Examiners, Position
Statement, retrieved March 16, 2010 from, http://www.bon.state.tx.us/practice/p osition.html
What is my role? Why do I need to know to these
stuff?