Across the country, concerns about unsafe staffing, inappropriate delegation, and pressure on nurses to accept responsibilities beyond their scope remain persistent challenges in clinical practice. Safe harbor laws offer nurses a legal and ethical mechanism to protect both themselves and their patients when they are given a clinical duty, directive, or workload that may compromise safe care. These laws establish a formal process for nurses to voice and document concerns, decline unsafe responsibilities, and request review of situations that may violate a nurse’s duty to a patient without fear of retaliation. The goal is to strengthen professional empowerment and support safe patient care.
What Safe Harbor Laws Do
Safe harbor laws allow nurses to invoke a protected process when they are asked to perform a task, care responsibility, or clinical action that conflicts with their professional judgment. Ideally, this prompts a collaborative discussion with a supervisor, leading to immediate resolution. If concerns remain, the nurse may decline to proceed, and the situation undergoes review. Once safe harbor is invoked, the nurse is protected from disciplinary action or employer retaliation while the issue is evaluated, ensuring nurses can speak up without fear. This reinforces a nurse’s duty to advocate for safe patient care and supports a culture of transparency and accountability.
Texas: Safe Harbor Through Peer Review
Texas has the most established safe harbor framework in the nation, embedded within its Nursing Practice Act (Texas Occupations Code, Chapter 303). When a nurse believes they are being asked to engage in conduct that violates their duty to a patient, they may invoke safe harbor, triggering review by a nursing peer review committee. Texas requires facilities employing a certain number of nurses to establish and maintain these committees, which evaluate both clinical competence and safety concerns. While this system provides robust structure and clear procedures, it also requires significant organizational resources to implement.
New Mexico: Safe Harbor as a Stand-Alone Protection
New Mexico takes a different approach. Rather than embedding safe harbor in peer review processes under the state nurse practice act, New Mexico establishes it as a stand-alone statutory protection (N.M. Stat. § 61-3A-3). When a nurse believes an assignment or order places a patient—or the nurse—at risk, they may invoke safe harbor to decline or request reassignment. Employers must have internal procedures for this process, but the emphasis is on immediate patient safety and nurse protection, not retrospective peer evaluation. With fewer structural requirements, this model is more adaptable across diverse healthcare settings, including rural or smaller facilities.
A Path Forward in Colorado
The Colorado Nurses Association (CNA) is actively exploring how best to model similar legislation in our state. Both the Workplace Advocacy Advisory and Networking Team (ANT) and the Sunset Review Nursing Group are discussing safe harbor concepts and assessing how a Colorado framework could be designed within our regulatory and organizational environment. Initial discussions suggest that Colorado may benefit from a stand-alone safe harbor statute, similar to New Mexico’s approach, rather than incorporating it into the Nurse Practice Act.
CNA welcomes nurses statewide to join the conversation and take part in this work. Whether your interests include advocacy, policy development, patient safety, or shaping a future safe harbor model in Colorado, your perspective is essential. If you would like to get involved, please connect with the Workplace Advocacy ANT or the Sunset Review Nursing Group through the Colorado Nurses Association website or MyCNA.
