Safe Harbor Nursing Peer ReviewIntroduction: With the revisions to the Nursing Peer Review statutes (effective 9/1/2007) and nursing peer reviewrules (effective 5/11/2008), new forms have been developed to make the process faster and easier for a nurse whobelieves he/she is being asked to accept an unsafe assignment, engage in conduct beyond the nurse's scope ofpractice, or engage in unprofessional or illegal conduct. Here is how it works:There are 3 Forms: (Please Do Not Send Safe Harbor Forms to the Board of Nursing)- Quick Request for Safe Harbor; and- Comprehensive Request for Safe Harbor; and- Safe Harbor Request to Question the Medical Reasonableness of a Physician's Order.The Quick Request Form is an abbreviated form to allow a nurse to quickly jot down the key informationnecessary to invoke Safe Harbor in writing as required by Rule 217.20 at the time the nurse is asked to accept whathe/she believes to be an unsafe assignment. Use of the form is not required, but is provided to make safe harbor aneasier process for the nurse.The Comprehensive Request for Safe Harbor Form is a sample form that may be used to document the more in-depth information that the nurse must commit to writing before leaving the work setting at the end of the workperiod. The nurse may still supply supporting documents at a later time, however the details of the eventssurrounding the request must be recorded prior to the nurse leaving the premises. The comprehensive form alsoincludes a fill-in-the-blank format that the peer review committee and CNO or nurse administrator can utilize todocument the safe harbor peer review process. Again, this form is not mandatory, but is offered a guide to theprocess. An entity required to have a peer review plan must have policies and procedures that encompass otheraspects both within and beyond the statutes and rules of peer review. In other words, it is not sufficient to use theBON Safe Harbor forms in place of official policies and procedures on nursing peer review.The third form is for those occasions when the reason for the nurse’s need to invoke Safe Harbor is related to theactions or orders of a physician. In this case, the nurse may not need to use either the Quick or the Comprehensiverequest forms, since it will be an individual physician who will make a determination, rather than a nursing peerreview committee. In other words, to question the medical reasonableness of a physicians order, a nurse willlikely only need to use this third form by itself.A facility or other entity establishing a nursing peer review plan may establish it’s own’ forms and procedures thatcomply with the peer review statutes and rule 217.20 Safe Harbor Peer Review.You may wish to review the Peer Review Frequently Asked Questions (FAQs)Peer Review Frequently AskedQuestions (web view or pdf version) in addition to the above BON Safe Harbor Forms. A Reference Table to helplocate rules and statutes relating to peer review topics is also available on the BON's web site under Nursing PeerReview.Review of the Safe Harbor Peer Review Rule in its entirety is also recommended:- Rule 217.20 Safe Harbor Peer Review and Whistleblower Protections.The rules relating to Incident-Based Peer Review include:- Rule 217.16 Minor Incident- Rule 217.19 Incident-Based Peer Review and Whistleblower ProtectionsThe rules are accessible on the BON web page at web view under "Nursing Laws and Rules"or pdf version) TheSafe Harbor forms and other documents are located under the "Nursing Practice" link.FAQs - Nursing Peer ReviewGENERAL PEER REVIEW INFORMATION (1) What is Peer Review? [Nursing Peer Review (NPR) §303.001(5)]Peer review is the evaluation of nursing services, the qualifications of a nurse, the quality of patient care rendered bynurses, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint including:a) the evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse;b) a report made to a nursing peer review committee concerning an activity under the committee’s review authority;c) a report made by a nursing peer review committee to another committee or to the Board as permitted or required by law; andd) implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of thecommittee.A Peer Review Committee may review the nursing practice of a LVN, RN, or APN (RN with advanced practice authorization).There are two kinds of nursing peer review:a) Incident-based (IBPR), in which case peer review is initiated by a facility, association, school, agency, or any other setting that utilizes the services of nurses; orb) Safe Harbor (SHPR), which may be initiated by a LVN, RN or APN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). 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.See revised rules 217.19 (Incident-Based Nursing Peer Review and Whistleblower Protections) and 217.20 (Safe Harbor Peer Review and Whistleblower Projections){http://www.bon.state.tx.us/nursinglaw/rr.html}(2) What is a nursing peer review committee? [NPR §303.001(4); 22TAC 217.19(a)(14), 217.20(a)(14)]It is a committee established under the authority of the governing body of a national, state, or local nursing association; a school of nursing; the nursing staff of a hospital, health science center, nursing home, home health agency, temporary nursing service, or other health care facility; or state agency or political subdivision for the purpose of conducting nursing peer review. The nursing peer review process is one of fact-finding, analysis, and study of events by nurses in a climate of collegial problem solving focused on obtaining all relevant information about an event.(3)Who must have a peer review plan? [NPR §303.0015 ]Any person or entity that employs, hires, or contracts for the services of 10 or more nurses (RNs, LVNs or any combination thereof) must have a Peer Review Plan; however, peer review of RNs is not mandatory if the facility employs less than 5 RNs. A person or entity required to have