June 17, 2025 • 21 mins
What happens when nurses join unions while navigating their professional obligations? Our eye-opening conversation with union leaders Jessica Walfort and Lindsay Spinney reveals the often misunderstood relationship between nursing advocacy and regulatory compliance.
The Texas Board of Nursing establishes the framework within which all nurses must operate – licensing qualified professionals and investigating complaints to maintain standards of care. But how does this regulatory environment interact with nurses' rights to organize and advocate? Our guests provide a rare glimpse into this delicate balance, emphasizing that union participation doesn't replace professional responsibilities but enhances nurses' ability to fulfill them through better working conditions.
Perhaps most revealing is the discussion around Safe Harbor provisions – legal protections designed to let nurses report unsafe conditions without fear of retaliation. While these protections exist on paper, our guests share sobering personal experiences of the barriers nurses face when attempting to use them. From management pressure to excessive documentation requirements, the gap between regulatory theory and workplace reality paints a troubling picture of the challenges facing today's nursing professionals.
The conversation highlights critical knowledge gaps in nursing education and practice. Many nurses receive minimal training on their rights and regulatory frameworks, creating an environment where misinformation flourishes. Our guests emphasize how unions provide essential education and support, helping nurses understand scope of practice issues and navigate the complex terrain of professional advocacy while maintaining license compliance.
Ready to better understand your rights and responsibilities as a nursing professional? Subscribe to Know Your Regulator and join us as we continue exploring the critical intersections of regulation, professional practice, and effective advocacy.
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Visit the resources we mentioned during this episode!
Learn more about the Nurse Practice Act (NPA):
https://www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp.html
Explore the current Texas Board of Nursing's Rules and Regulations:
https://www.bon.texas.gov/laws_and_rules_rules_and_regulations.asp.html
Get the scoop on your Scope of Practice:
https://www.bon.texas.gov/practice_scope_of_practice_rn.asp.html
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Get more information, details and resources on Know Your Regulator - https://www.belolaw.com/know-your-regulator
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem contact an
attorney.
Welcome to Know your Regulator,the podcast that inspires you
to engage.
I am your host, Simone Murphy,and co-hosting with me today is
(00:21):
the Director of Legal Servicesat Bertolino Law Firm, Troy
Bollier.
Hey, Troy.
Speaker 2 (00:26):
Hi Simone.
Looking forward to ourconversation today.
I think we have a realmeaningful episode where we're
going to talk about nurses andhow you can engage in union
activity but also stay compliantand aligned with the
obligations.
You know the rules and the lawsfrom the Texas Board of Nursing
(00:47):
, so really excited to have ourguests here today.
Speaker 1 (00:51):
Yes, absolutely.
We both know there is a ton ofvalue in nurses knowing and
understanding the rules thatgovern them, but beyond that, it
is so important that nursesknow and understand their rights
.
We're thrilled to be joined bytwo brilliant nurses who bring
real world expertise in unionleadership and advocacy.
I'm very pleased to welcomeJessica Walford and Lindsay
(01:14):
Spinney.
Thanks for joining us today,y'all.
Yeah, we're excited.
Yeah, thanks for having us.
Absolutely, we're really gladto have you.
Thanks for being here.
So, troy, before we dive in,can you kind of set the stage
for our listeners?
What exactly does the TexasBoard of Nursing regulate?
Speaker 2 (01:34):
Yeah, absolutely so.
The Texas Board of Nursing isthe statewide regulatory body
that licenses and regulatesanyone who's acting as a nurse
in Texas.
Right, you have to have alicense from the Board of
Nursing to engage in nursingactivity, otherwise it's
(01:55):
unlicensed activity.
That's a danger to the public,right?
So nurses have to go to school,they have to meet certain
minimum requirements and gothrough an application process
where they demonstrate thatthey're qualified, including
completing an exam, any requiredcoursework demonstrating that
they have the right degree andthat kind of thing.
So that's one big publicprotection aspect of the board.
(02:19):
The other aspect is theenforcement kind of regulatory
process.
Right, they're the ones ifthere is a complaint, if there
is a concern about a breach ofthe standard of care that nurses
have to uphold, that the publiccan file a complaint with the
board and they'll investigate itand determine whether there
(02:39):
were any violations and if thereis any action that needs to be
taken to protect the public.
I mean, sometimes it's just amatter of maybe action that
needs to be taken to protect thepublic.
I mean, sometimes it's just amatter of maybe a nurse needs to
brush up on some training aboutcertain aspects of care.
Other times there could be moreserious allegations involving
ethics or deliberate misconduct,but those are the two primary
functions of the board is tomake sure that the right people
(03:03):
are licensed, that people thatare competent and have the
training, skills and knowledge,and then, as they go forward,
they maintain those minimumstandards when they're caring
for patients and if there is aproblem, there's a process to
address it.
Speaker 1 (03:18):
Thank you, Troy, for that wonderful explanation.
Now let's kind of get back tohow that fits in to union
involvement, because we knowthat those responsibilities
don't take a backseat whennurses advocate for change.
So, Jessica, I'd like to startwith you.
Can you walk us through whatunion participation looks like
in the nursing profession?
Speaker 3 (03:47):
So it kind of goes along.
I mean, everything that we dois still within the Board of
Nursing regulations.
You still do your job, your jobis still first.
Your job doesn't change.
It's really just communicatingand talking to your peers about
unions, because, especially herein Texas, about unions, because
especially here in Texas mostnurses have have no experience
(04:08):
with unions.
I did, I do from previous jobs,previous states that I've
worked in, so communicating withthem about that was a big part
of it.
And you just vote, you vote andyou support your union really
and it's.
It's pretty separate from yourjob.
You still do your job, justlike you would before, just like
(04:29):
you would as a non-union nurse.
You're just advocating foryourself and for your patients
to have safe staffing ratios,things like that yeah, so kind
of just making sure that you'reeducated and involved with your
union.
Speaker 2 (04:46):
Yeah.
Speaker 1 (04:47):
Makes sense and, lindsay, as nurses are
organizing and they'readvocating, what types of
regulatory awareness ortrainings do you think are
really helpful?
Speaker 4 (04:58):
So in my experience, the union really educated me a
lot at the beginning and then Ieducated myself.
Unfortunately, there's not alot out there.
There's nothing from the boardof nursing.
The board of nursing is toprotect the public, and then to
all of the things that Troyalready went over.
But you know, from myperspective, that's kind of what
(05:19):
they're there for and theunions do, and the labor
movement in general, I think inthis particular case, is there
to protect nurses but alsoprotect and advocate for
patients.
So there's a lot of educationthat comes from them past
practice, there's legaleducation in some areas, but
(05:40):
it's also it's very importantand it's stressed from the very
beginning when you start talkingabout this, that first and
foremost, you protect yourlicense, which means doing your
job as a nurse and hearing toall the things, so practicing
within scope and things likethat.
But I think that's part of themovement and why it's happening
(06:03):
right now is people are reallywanting to have more of a voice
and trying to seek out ways todo that.
Speaker 1 (06:20):
And even in Texas, where it's so rare having access
to unions and to really crucialjust overall and kind of doing
your research, making sure thatyou're involved and you know if
you see something kind ofreading up on that or going a
little bit further than justwhat's presented at face value,
that makes sense.
Yeah, and it's kind of a bummerthat there's not a lot of you
(06:41):
know of education out there.
I think, like you said, that'sprobably a big reason for the
movement and hopefully we cansee some of that come about in
the future.
What are some of the biggestchallenges that y'all are seeing
with nurses?
When the union activities arekind of intersecting with
regulations, are you seeing alot of challenges or is it kind
(07:03):
of pretty straightforward beingunionized and still being under
those governing rules?
Speaker 3 (07:11):
It's it's pretty easy to still be under your scope of
practice and be because that'swhat the union supports.
So to help supposed to helpsupport you to do that even
better by having ratios andstuff.
I think one of the biggest likeroadblocks is the lack of
knowledge and the falseinformation that you get from
(07:35):
the hospitals and frommanagement.
Speaker 1 (07:37):
I've heard that before and or just really kind
of lie to you about what whatthe rules really are, and
sometimes have their policygovern what the board of nursing
says, and obviously that can bereally frustrating and
confusing, especially to thoseyounger nurses.
And you know, are there any,are there any tips that you guys
(07:58):
would have to kind of navigate?
Something like that.
Speaker 4 (08:02):
I think communication is key and it's the word that
I'll keep coming back tohonestly in this entire podcast,
because I do think that that'skey.
I think what Jessica is sayingis true.
I've witnessed it.
I think that it's reallyconfusing to nurses when you
have other nurses lying to them.
(08:23):
A lot of times there are nursesthat are in management and so
they have whatever priorities oragenda or policies that they
need to push from the peoplethat are above them and it's a
there's it supports like aculture of fear, which, in my
opinion, should never even existin healthcare, because this is
a you like, see something, yousay something, where all our
(08:46):
patients come first, all of that.
So there shouldn't be any fear,in my opinion, in the field.
I just don't think there's roomfor it.
So I understand that thehospital is a business and has
to function and support itselfand things like that.
I do think that there's a wayto do both to have good health
(09:06):
care and to also stay afloat asa hospital.
I just think that we have totake the power back as nurses.
I mean, we are a huge part ofthe hospital functioning and I
think we just need a culturechange.
I think that's what we'reseeing right now is new
generation people with differentviews coming in and taking it
(09:31):
upon themselves to educatethemselves.
Nursing, know, nursing ingeneral, I think, is a field
that's ever evolving.
Healthcare is ever evolving andso, by default, our rights and
our practice and stuff is alsoever evolving, so it just
requires us to stay educated,keep communicating and take the
initiative upon ourselvescommunicating and take the
(09:56):
initiative upon ourselves.
Speaker 2 (09:57):
You know, to amplify off of what Lindsay and Jessica
are saying, there are legalprovisions in Texas law.
It's, you know, it's chapter 301of the Texas Occupations Code
is the chapter in state law thatgoverns the Board of Nursing,
and they do have safe harborprovisions.
They do have provisions andthey're spelled out also in the
board's rules where nurses can,when they see something unsafe,
(10:20):
when they're concerned aboutinadequate staffing or lack of
training such that they don'tthink they're qualified to do
something, they can go tomanagement, go to management and
they can say hey, I have thisconcern, I need to notify you
that I think this is unsafe andit's going to expose the patient
to risk.
So the law in that sense issupportive, I think is
(10:42):
consistent with a lot of theunion's goals in making sure
that nurses are meeting thatprimary duty of patient care.
And so there's ways to do that.
I think that's the real key is,people need more education and
knowledge about hey, what's thesafe harbor process?
How do I make that writtennotice?
(11:03):
How do I follow through on thatprocess if it needs peer review
committee to look at it?
But there's a process for thatso that nurses don't just feel
like they're kind of alone atsea and don't have any resources
or any help when a difficultsituation comes up.
Speaker 3 (11:20):
Sure, that is a good thing that we have that we can
do, but I can speak on that frompersonal experience.
The first hospital I worked at,I thought that we were doing
that every shift.
We were supposedly calling safeharbor and it never actually.
It was never actually happening, first off.
Second off, I, at the hospitalthat I work at now, I called
(11:44):
safe harbor about a year ago.
It's very difficult to do.
You are very pressured into notdoing it and almost almost like
they're trying to.
The manager came to me and waslike, are you sure you want to
do this?
Basically like threatening meand I said yeah, I do want to do
this because I'm not scared ofdoing it, but it's a scary thing
(12:06):
to do, especially for newnurses who don't necessarily
know what a unit should looklike and how a unit should run.
And it's education, like you'resaying, knowing how to do it,
because it's not easy to do,especially when you have a full
load of patients that you haveto be taking care of as well,
(12:28):
and it's a scary thing.
You have to be brave.
Speaker 4 (12:32):
I think it's a in practice it's like it's.
It's great that that exists,that that law is there and
explicit.
I think in practice it's verydifferent.
I would be hard pressed to findvery many nurses that were able
to successfully call safeharbor, put the paperwork
(12:52):
through, do everything and haveit actually go through.
You know, being on monthlymeetings at the hospital you'll
hear Safe Harbor was called onthis floor at this time and it
wasn't processed becausesomething wasn't filled out
right, the chain of commandwasn't followed exactly.
The burden is very high on thenurse.
(13:14):
It's a time-consuming process,it's fairly tedious and, like
Jessica said, my experience aswell.
I've not personally called SafeHarbor but I've been present
and supported that on my unitand there was immediate pressure
and questioning and it's it issort of threatening, it's more
(13:35):
of a bullying kind of thing.
It's a cultural situation where, honestly, the again it's a
chain of command thing and youknow the manager of the unit
doesn't want safe Harbor to beon their record.
The nurse soup, the house soup,doesn't want it on their record
with the company.
(13:55):
So in in practicing it's reallydifficult.
Speaker 2 (14:00):
I completely agree with what you guys are saying
and I think that's where theunion's role, with advocacy and
education and training, is soimportant because, just like
Jessica said, it's a scary thingto have to tell somebody in a
position of authorityrespectfully, I can't do this,
I'm not allowed to do this.
Let me explain to you why andlet me document it properly.
(14:22):
Because, like you said, one Iis not dotted or one T is not
crossed and it can create issueswhere it's not a valid
invocation.
Speaker 1 (14:32):
It really speaks to that kind of culture shift, that
or this, like it's systemic, avalid invocation, and it really
speaks to that kind of cultureshift, that or this, like it's
systemic.
Now, you know, and it's the.
There's so much pressure andpushback that you know, not to
mention while y'all are on thefloor, like treating patients in
real time, there's so muchpushback that, yeah, I mean, if
(14:54):
you don't know your rights, youdon't know how to safely
advocate for yourself, that youcould just say okay and you know
, and then nothing ever becomesof it.
Speaker 2 (15:03):
Well, and Simone, that's what I was going to say.
You know, to Jessica andLindsay's point if somebody
feels that pressure and kind ofbacks off and says, well, I'm
just going to go do this, thenthey run that risk of did I do
something that wasunprofessional conduct, did I
violate that standard of care,and maybe something bad happens,
and then they do get reported.
(15:25):
So it's a really challenging,difficult dynamic and I really
appreciate both of y'all forbeing advocates and trying to
get the word out and educatepeople, because that's really
what it's all about.
Speaker 1 (15:39):
We've kind of touched on this already throughout the
episode briefly, but what kindof support do you think is the
most important for nurses tounderstand their regulatory
landscape?
I'm thinking probably unioninvolvement and just.
Speaker 4 (15:57):
Yeah, I think that's definitely a go-to for me at
this point.
But I also, you know, I willsay, in nursing school you get
very little in the state ofTexas some hearings, but they
were all disciplinary hearingsand they were for very different
(16:26):
things.
But it wasn't like patientneglect, it wasn't things that
we're talking about today.
It was very specific individualnurses and implications for
their license.
But I think the board ofnursing, from my perspective, is
a little bit of a scary topicfor people because it feels like
(16:47):
they're only there if somethingbad happens to you as a nurse.
It doesn't feel like anapproachable entity.
And I'll be very transparentthat this is the first
professional license that I'vepersonally had, so I don't know
what what other entities arelike.
But you know all that we got innursing school was here's the
(17:09):
Nursing Practice Act, which isabout, I want to say, like 65
pages.
It's pretty complex language insome areas.
Learn it, abide by it, go onwith your life, kind of thing.
And you know we apply for alicense and then we renew with
our CEs and go about ourbusiness and for a lot of people
, until you're put in asituation you don't revisit it.
(17:32):
I feel pretty confident insaying that it's not an easy
document to read.
It's hard sometimes to see howit applies specifically, like if
you're in a hospital, certainthings just don't apply or maybe
not relevant.
So I think it's something thatyou know people again are going
to have to go educate themselveson, and I would recommend doing
(17:53):
that because you don't want tobe in the position of waiting
until something happens so youcan go to the Board of Nursing
website and look at the PracticeAct periodically.
It changes every few years,they update things but it's
definitely about educatingyourself and I also think, on
top of the Nursing Practice Act,just being really aware of what
(18:14):
your scope of practice is.
That's also something on theBoard of Nursing website.
I think it's really easy in thiscurrent climate, with things
like short staffing but just ingeneral, like the progress that
health care is making and thenall of the documentation and the
technology, I think it's reallyeasy to get into something
called like scope creep and todo things that are like they
(18:38):
seem okay and this you know,somebody of authority is asking
you to do this or telling youit's okay, or you're seeing
other people do it.
I think it's just reallyimportant.
That's a very short, like onepager.
I think that's a very easything to you know.
At minimum, when you're youknow, like once a year kind of
thing, part of your CEs foryourself would be to kind of
(18:59):
look at these documents and atleast familiarize yourself to
some degree.
Speaker 1 (19:04):
Yeah, that's fantastic advice, absolutely.
Speaker 2 (19:07):
Simone.
To Lindsay's point, not justthe Nurse Practices Act but the
board rules too.
The board does a ton ofexplaining what the law means,
filling in the gaps in thestatute.
There's a whole host ofobligations and requirements
that are not even in the statute, that are in the board's rules.
(19:28):
So definitely education is abig part of that.
Speaker 1 (19:31):
And I know that nurses are crazy busy.
So that's why we've, you know,got know your regulator.
We can, you know, kind of putthat in layman's terms for you
to better understand the rulesand regulations that you know
you're bound to.
Well, this has been a reallygreat conversation, guys.
Thank you very much for joiningus and giving us this insight
and knowledge into how nursescan really protect themselves
(19:54):
and advocate for safeassignments and, you know, just
doing better overall in theindustry.
Speaker 2 (20:04):
Yeah, thanks for having me.
Yeah, definitely, the more youknow your regulatory boundaries,
I think, the more powerfullyyou can advocate, and I really
appreciate both of y'all comingon the podcast and, you know,
talking about these important,challenging things that I think
are going to be at the forefrontof issues that nurses are
dealing with over the nextseveral years.
Speaker 3 (20:23):
Yeah, of course, I hope to see it get better.
I hope to see more unions andstronger unions in Texas,
similar to California, which ismy favorite place to work so far
.
Speaker 1 (20:34):
Well, that's awesome.
Yes, I hope we can kind of seethat bureaucracy go out the
window, especially with the safeharbor.
I mean, that's just insane.
You've got to run it up thechain and by the time it gets
there, is it even you know?
Is that even still applicable?
So well, a big thanks to ourlovely guests and thank you so
(20:55):
much to our listeners.
Stay engaged with yourregulatory board, connected in
your workplace, and if you needhelp find professionals who
understand both sides of thecoin, be sure to subscribe to
Know your Regulator and checkout our resources in the
description below.
Until next time, stay inspiredand continue engaging with your
(21:15):
regulatory agency.
Know your Regulator the podcastthat inspires you to engage.
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem contact an
attorney.
Welcome to Know your Regulator,the podcast that inspires you
to engage.
I am your host, Simone Murphy,and co-hosting with me today is
(00:21):
the Director of Legal Servicesat Bertolino Law Firm, Troy
Bollier.
Hey, Troy.
Speaker 2 (00:26):
Hi Simone.
Looking forward to ourconversation today.
I think we have a realmeaningful episode where we're
going to talk about nurses andhow you can engage in union
activity but also stay compliantand aligned with the
obligations.
You know the rules and the lawsfrom the Texas Board of Nursing
(00:47):
, so really excited to have ourguests here today.
Speaker 1 (00:51):
Yes, absolutely.
We both know there is a ton ofvalue in nurses knowing and
understanding the rules thatgovern them, but beyond that, it
is so important that nursesknow and understand their rights
.
We're thrilled to be joined bytwo brilliant nurses who bring
real world expertise in unionleadership and advocacy.
I'm very pleased to welcomeJessica Walford and Lindsay
(01:14):
Spinney.
Thanks for joining us today,y'all.
Yeah, we're excited.
Yeah, thanks for having us.
Absolutely, we're really gladto have you.
Thanks for being here.
So, troy, before we dive in,can you kind of set the stage
for our listeners?
What exactly does the TexasBoard of Nursing regulate?
Speaker 2 (01:34):
Yeah, absolutely so.
The Texas Board of Nursing isthe statewide regulatory body
that licenses and regulatesanyone who's acting as a nurse
in Texas.
Right, you have to have alicense from the Board of
Nursing to engage in nursingactivity, otherwise it's
(01:55):
unlicensed activity.
That's a danger to the public,right?
So nurses have to go to school,they have to meet certain
minimum requirements and gothrough an application process
where they demonstrate thatthey're qualified, including
completing an exam, any requiredcoursework demonstrating that
they have the right degree andthat kind of thing.
So that's one big publicprotection aspect of the board.
(02:19):
The other aspect is theenforcement kind of regulatory
process.
Right, they're the ones ifthere is a complaint, if there
is a concern about a breach ofthe standard of care that nurses
have to uphold, that the publiccan file a complaint with the
board and they'll investigate itand determine whether there
(02:39):
were any violations and if thereis any action that needs to be
taken to protect the public.
I mean, sometimes it's just amatter of maybe action that
needs to be taken to protect thepublic.
I mean, sometimes it's just amatter of maybe a nurse needs to
brush up on some training aboutcertain aspects of care.
Other times there could be moreserious allegations involving
ethics or deliberate misconduct,but those are the two primary
functions of the board is tomake sure that the right people
(03:03):
are licensed, that people thatare competent and have the
training, skills and knowledge,and then, as they go forward,
they maintain those minimumstandards when they're caring
for patients and if there is aproblem, there's a process to
address it.
Speaker 1 (03:18):
Thank you, Troy, for that wonderful explanation.
Now let's kind of get back tohow that fits in to union
involvement, because we knowthat those responsibilities
don't take a backseat whennurses advocate for change.
So, Jessica, I'd like to startwith you.
Can you walk us through whatunion participation looks like
in the nursing profession?
Speaker 3 (03:47):
So it kind of goes along.
I mean, everything that we dois still within the Board of
Nursing regulations.
You still do your job, your jobis still first.
Your job doesn't change.
It's really just communicatingand talking to your peers about
unions, because, especially herein Texas, about unions, because
especially here in Texas mostnurses have have no experience
(04:08):
with unions.
I did, I do from previous jobs,previous states that I've
worked in, so communicating withthem about that was a big part
of it.
And you just vote, you vote andyou support your union really
and it's.
It's pretty separate from yourjob.
You still do your job, justlike you would before, just like
(04:29):
you would as a non-union nurse.
You're just advocating foryourself and for your patients
to have safe staffing ratios,things like that yeah, so kind
of just making sure that you'reeducated and involved with your
union.
Speaker 2 (04:46):
Yeah.
Speaker 1 (04:47):
Makes sense and, lindsay, as nurses are
organizing and they'readvocating, what types of
regulatory awareness ortrainings do you think are
really helpful?
Speaker 4 (04:58):
So in my experience, the union really educated me a
lot at the beginning and then Ieducated myself.
Unfortunately, there's not alot out there.
There's nothing from the boardof nursing.
The board of nursing is toprotect the public, and then to
all of the things that Troyalready went over.
But you know, from myperspective, that's kind of what
(05:19):
they're there for and theunions do, and the labor
movement in general, I think inthis particular case, is there
to protect nurses but alsoprotect and advocate for
patients.
So there's a lot of educationthat comes from them past
practice, there's legaleducation in some areas, but
(05:40):
it's also it's very importantand it's stressed from the very
beginning when you start talkingabout this, that first and
foremost, you protect yourlicense, which means doing your
job as a nurse and hearing toall the things, so practicing
within scope and things likethat.
But I think that's part of themovement and why it's happening
(06:03):
right now is people are reallywanting to have more of a voice
and trying to seek out ways todo that.
Speaker 1 (06:20):
And even in Texas, where it's so rare having access
to unions and to really crucialjust overall and kind of doing
your research, making sure thatyou're involved and you know if
you see something kind ofreading up on that or going a
little bit further than justwhat's presented at face value,
that makes sense.
Yeah, and it's kind of a bummerthat there's not a lot of you
(06:41):
know of education out there.
I think, like you said, that'sprobably a big reason for the
movement and hopefully we cansee some of that come about in
the future.
What are some of the biggestchallenges that y'all are seeing
with nurses?
When the union activities arekind of intersecting with
regulations, are you seeing alot of challenges or is it kind
(07:03):
of pretty straightforward beingunionized and still being under
those governing rules?
Speaker 3 (07:11):
It's it's pretty easy to still be under your scope of
practice and be because that'swhat the union supports.
So to help supposed to helpsupport you to do that even
better by having ratios andstuff.
I think one of the biggest likeroadblocks is the lack of
knowledge and the falseinformation that you get from
(07:35):
the hospitals and frommanagement.
Speaker 1 (07:37):
I've heard that before and or just really kind
of lie to you about what whatthe rules really are, and
sometimes have their policygovern what the board of nursing
says, and obviously that can bereally frustrating and
confusing, especially to thoseyounger nurses.
And you know, are there any,are there any tips that you guys
(07:58):
would have to kind of navigate?
Something like that.
Speaker 4 (08:02):
I think communication is key and it's the word that
I'll keep coming back tohonestly in this entire podcast,
because I do think that that'skey.
I think what Jessica is sayingis true.
I've witnessed it.
I think that it's reallyconfusing to nurses when you
have other nurses lying to them.
(08:23):
A lot of times there are nursesthat are in management and so
they have whatever priorities oragenda or policies that they
need to push from the peoplethat are above them and it's a
there's it supports like aculture of fear, which, in my
opinion, should never even existin healthcare, because this is
a you like, see something, yousay something, where all our
(08:46):
patients come first, all of that.
So there shouldn't be any fear,in my opinion, in the field.
I just don't think there's roomfor it.
So I understand that thehospital is a business and has
to function and support itselfand things like that.
I do think that there's a wayto do both to have good health
(09:06):
care and to also stay afloat asa hospital.
I just think that we have totake the power back as nurses.
I mean, we are a huge part ofthe hospital functioning and I
think we just need a culturechange.
I think that's what we'reseeing right now is new
generation people with differentviews coming in and taking it
(09:31):
upon themselves to educatethemselves.
Nursing, know, nursing ingeneral, I think, is a field
that's ever evolving.
Healthcare is ever evolving andso, by default, our rights and
our practice and stuff is alsoever evolving, so it just
requires us to stay educated,keep communicating and take the
initiative upon ourselvescommunicating and take the
(09:56):
initiative upon ourselves.
Speaker 2 (09:57):
You know, to amplify off of what Lindsay and Jessica
are saying, there are legalprovisions in Texas law.
It's, you know, it's chapter 301of the Texas Occupations Code
is the chapter in state law thatgoverns the Board of Nursing,
and they do have safe harborprovisions.
They do have provisions andthey're spelled out also in the
board's rules where nurses can,when they see something unsafe,
(10:20):
when they're concerned aboutinadequate staffing or lack of
training such that they don'tthink they're qualified to do
something, they can go tomanagement, go to management and
they can say hey, I have thisconcern, I need to notify you
that I think this is unsafe andit's going to expose the patient
to risk.
So the law in that sense issupportive, I think is
(10:42):
consistent with a lot of theunion's goals in making sure
that nurses are meeting thatprimary duty of patient care.
And so there's ways to do that.
I think that's the real key is,people need more education and
knowledge about hey, what's thesafe harbor process?
How do I make that writtennotice?
(11:03):
How do I follow through on thatprocess if it needs peer review
committee to look at it?
But there's a process for thatso that nurses don't just feel
like they're kind of alone atsea and don't have any resources
or any help when a difficultsituation comes up.
Speaker 3 (11:20):
Sure, that is a good thing that we have that we can
do, but I can speak on that frompersonal experience.
The first hospital I worked at,I thought that we were doing
that every shift.
We were supposedly calling safeharbor and it never actually.
It was never actually happening, first off.
Second off, I, at the hospitalthat I work at now, I called
(11:44):
safe harbor about a year ago.
It's very difficult to do.
You are very pressured into notdoing it and almost almost like
they're trying to.
The manager came to me and waslike, are you sure you want to
do this?
Basically like threatening meand I said yeah, I do want to do
this because I'm not scared ofdoing it, but it's a scary thing
(12:06):
to do, especially for newnurses who don't necessarily
know what a unit should looklike and how a unit should run.
And it's education, like you'resaying, knowing how to do it,
because it's not easy to do,especially when you have a full
load of patients that you haveto be taking care of as well,
(12:28):
and it's a scary thing.
You have to be brave.
Speaker 4 (12:32):
I think it's a in practice it's like it's.
It's great that that exists,that that law is there and
explicit.
I think in practice it's verydifferent.
I would be hard pressed to findvery many nurses that were able
to successfully call safeharbor, put the paperwork
(12:52):
through, do everything and haveit actually go through.
You know, being on monthlymeetings at the hospital you'll
hear Safe Harbor was called onthis floor at this time and it
wasn't processed becausesomething wasn't filled out
right, the chain of commandwasn't followed exactly.
The burden is very high on thenurse.
(13:14):
It's a time-consuming process,it's fairly tedious and, like
Jessica said, my experience aswell.
I've not personally called SafeHarbor but I've been present
and supported that on my unitand there was immediate pressure
and questioning and it's it issort of threatening, it's more
(13:35):
of a bullying kind of thing.
It's a cultural situation where, honestly, the again it's a
chain of command thing and youknow the manager of the unit
doesn't want safe Harbor to beon their record.
The nurse soup, the house soup,doesn't want it on their record
with the company.
(13:55):
So in in practicing it's reallydifficult.
Speaker 2 (14:00):
I completely agree with what you guys are saying
and I think that's where theunion's role, with advocacy and
education and training, is soimportant because, just like
Jessica said, it's a scary thingto have to tell somebody in a
position of authorityrespectfully, I can't do this,
I'm not allowed to do this.
Let me explain to you why andlet me document it properly.
(14:22):
Because, like you said, one Iis not dotted or one T is not
crossed and it can create issueswhere it's not a valid
invocation.
Speaker 1 (14:32):
It really speaks to that kind of culture shift, that
or this, like it's systemic, avalid invocation, and it really
speaks to that kind of cultureshift, that or this, like it's
systemic.
Now, you know, and it's the.
There's so much pressure andpushback that you know, not to
mention while y'all are on thefloor, like treating patients in
real time, there's so muchpushback that, yeah, I mean, if
(14:54):
you don't know your rights, youdon't know how to safely
advocate for yourself, that youcould just say okay and you know
, and then nothing ever becomesof it.
Speaker 2 (15:03):
Well, and Simone, that's what I was going to say.
You know, to Jessica andLindsay's point if somebody
feels that pressure and kind ofbacks off and says, well, I'm
just going to go do this, thenthey run that risk of did I do
something that wasunprofessional conduct, did I
violate that standard of care,and maybe something bad happens,
and then they do get reported.
(15:25):
So it's a really challenging,difficult dynamic and I really
appreciate both of y'all forbeing advocates and trying to
get the word out and educatepeople, because that's really
what it's all about.
Speaker 1 (15:39):
We've kind of touched on this already throughout the
episode briefly, but what kindof support do you think is the
most important for nurses tounderstand their regulatory
landscape?
I'm thinking probably unioninvolvement and just.
Speaker 4 (15:57):
Yeah, I think that's definitely a go-to for me at
this point.
But I also, you know, I willsay, in nursing school you get
very little in the state ofTexas some hearings, but they
were all disciplinary hearingsand they were for very different
(16:26):
things.
But it wasn't like patientneglect, it wasn't things that
we're talking about today.
It was very specific individualnurses and implications for
their license.
But I think the board ofnursing, from my perspective, is
a little bit of a scary topicfor people because it feels like
(16:47):
they're only there if somethingbad happens to you as a nurse.
It doesn't feel like anapproachable entity.
And I'll be very transparentthat this is the first
professional license that I'vepersonally had, so I don't know
what what other entities arelike.
But you know all that we got innursing school was here's the
(17:09):
Nursing Practice Act, which isabout, I want to say, like 65
pages.
It's pretty complex language insome areas.
Learn it, abide by it, go onwith your life, kind of thing.
And you know we apply for alicense and then we renew with
our CEs and go about ourbusiness and for a lot of people
, until you're put in asituation you don't revisit it.
(17:32):
I feel pretty confident insaying that it's not an easy
document to read.
It's hard sometimes to see howit applies specifically, like if
you're in a hospital, certainthings just don't apply or maybe
not relevant.
So I think it's something thatyou know people again are going
to have to go educate themselveson, and I would recommend doing
(17:53):
that because you don't want tobe in the position of waiting
until something happens so youcan go to the Board of Nursing
website and look at the PracticeAct periodically.
It changes every few years,they update things but it's
definitely about educatingyourself and I also think, on
top of the Nursing Practice Act,just being really aware of what
(18:14):
your scope of practice is.
That's also something on theBoard of Nursing website.
I think it's really easy in thiscurrent climate, with things
like short staffing but just ingeneral, like the progress that
health care is making and thenall of the documentation and the
technology, I think it's reallyeasy to get into something
called like scope creep and todo things that are like they
(18:38):
seem okay and this you know,somebody of authority is asking
you to do this or telling youit's okay, or you're seeing
other people do it.
I think it's just reallyimportant.
That's a very short, like onepager.
I think that's a very easything to you know.
At minimum, when you're youknow, like once a year kind of
thing, part of your CEs foryourself would be to kind of
(18:59):
look at these documents and atleast familiarize yourself to
some degree.
Speaker 1 (19:04):
Yeah, that's fantastic advice, absolutely.
Speaker 2 (19:07):
Simone.
To Lindsay's point, not justthe Nurse Practices Act but the
board rules too.
The board does a ton ofexplaining what the law means,
filling in the gaps in thestatute.
There's a whole host ofobligations and requirements
that are not even in the statute, that are in the board's rules.
(19:28):
So definitely education is abig part of that.
Speaker 1 (19:31):
And I know that nurses are crazy busy.
So that's why we've, you know,got know your regulator.
We can, you know, kind of putthat in layman's terms for you
to better understand the rulesand regulations that you know
you're bound to.
Well, this has been a reallygreat conversation, guys.
Thank you very much for joiningus and giving us this insight
and knowledge into how nursescan really protect themselves
(19:54):
and advocate for safeassignments and, you know, just
doing better overall in theindustry.
Speaker 2 (20:04):
Yeah, thanks for having me.
Yeah, definitely, the more youknow your regulatory boundaries,
I think, the more powerfullyyou can advocate, and I really
appreciate both of y'all comingon the podcast and, you know,
talking about these important,challenging things that I think
are going to be at the forefrontof issues that nurses are
dealing with over the nextseveral years.
Speaker 3 (20:23):
Yeah, of course, I hope to see it get better.
I hope to see more unions andstronger unions in Texas,
similar to California, which ismy favorite place to work so far
.
Speaker 1 (20:34):
Well, that's awesome.
Yes, I hope we can kind of seethat bureaucracy go out the
window, especially with the safeharbor.
I mean, that's just insane.
You've got to run it up thechain and by the time it gets
there, is it even you know?
Is that even still applicable?
So well, a big thanks to ourlovely guests and thank you so
(20:55):
much to our listeners.
Stay engaged with yourregulatory board, connected in
your workplace, and if you needhelp find professionals who
understand both sides of thecoin, be sure to subscribe to
Know your Regulator and checkout our resources in the
description below.
Until next time, stay inspiredand continue engaging with your
(21:15):
regulatory agency.
Know your Regulator the podcastthat inspires you to engage.
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