N3375 Health Policy & Legal Aspects
Module 4: Reflection Assignment – Safe Harbor
Submit by 2359 (CT) Saturday of Module 4.
Name: Date: 02-04-2024
Overview: Safe Harbor
Due to staffing shortages and the unpredictability of hospital needs, nurses are sometimes asked
to take on assignments outside their normal routines. As a healthcare professional, you must
understand your options when asked to take on such assignments, the risks associated with
accepting some assignments, and the protections afforded you by the law. Reflect upon your
learning about the Safe Harbor protection as well as any experiences you have had in this realm.
Then follow the instructions and complete the Safe Harbor form based upon a fictitious scenario.
Refer to your course readings and lectures as you complete the assignment.
Performance Objectives:
Explain and apply appropriate options regarding acceptance or rejection of assignments,
including the use of Safe Harbor.
Answer fill in the blank questions according to the readings this week.
Rubric
Use this rubric to guide your work on the assignment, “Safe Harbor.”
Task Accomplished Proficient Needs Improvement
Part 1
Question 1- Four Choices Correctly states 4 Correctly states 3 Correctly states 1
answers (20 points) answers (15 points) answer (5 points)
Correctly states 2 Does not answer
answers (10 points) question OR answers
incorrectly (0 points)
Question 2- Rule 217.11 1(T) and Correctly states rule and Correctly states rule and Does not state rule OR
rationale rationale with 3 rationale with 2 does not state rationale
complete sentences (20 sentences answers (15
points) points) (10 points)
Correctly states rule and Does not answer
©2020 UT Arlington College of Nursing 1
, N3375 Health Policy & Legal Aspects
rationale with 1 question
sentence answers (10 OR Incorrect rule OR
points) incorrect rationale
(0 points)
Question 3- Two Forms Correctly lists 2 forms Correctly lists 1 form Does not answer
(10 points) (5 points) question (0 points)
(50 points)
Part 2
Fills out form correctly Aspects of form are Does not fill out form
and in full using case missing (0 points)
Safe Harbor Form scenario information (25 points)
(50 points)
(50 points)
©2020 UT Arlington College of Nursing 2
Module 4: Reflection Assignment – Safe Harbor
Submit by 2359 (CT) Saturday of Module 4.
Name: Date: 02-04-2024
Overview: Safe Harbor
Due to staffing shortages and the unpredictability of hospital needs, nurses are sometimes asked
to take on assignments outside their normal routines. As a healthcare professional, you must
understand your options when asked to take on such assignments, the risks associated with
accepting some assignments, and the protections afforded you by the law. Reflect upon your
learning about the Safe Harbor protection as well as any experiences you have had in this realm.
Then follow the instructions and complete the Safe Harbor form based upon a fictitious scenario.
Refer to your course readings and lectures as you complete the assignment.
Performance Objectives:
Explain and apply appropriate options regarding acceptance or rejection of assignments,
including the use of Safe Harbor.
Answer fill in the blank questions according to the readings this week.
Rubric
Use this rubric to guide your work on the assignment, “Safe Harbor.”
Task Accomplished Proficient Needs Improvement
Part 1
Question 1- Four Choices Correctly states 4 Correctly states 3 Correctly states 1
answers (20 points) answers (15 points) answer (5 points)
Correctly states 2 Does not answer
answers (10 points) question OR answers
incorrectly (0 points)
Question 2- Rule 217.11 1(T) and Correctly states rule and Correctly states rule and Does not state rule OR
rationale rationale with 3 rationale with 2 does not state rationale
complete sentences (20 sentences answers (15
points) points) (10 points)
Correctly states rule and Does not answer
©2020 UT Arlington College of Nursing 1
, N3375 Health Policy & Legal Aspects
rationale with 1 question
sentence answers (10 OR Incorrect rule OR
points) incorrect rationale
(0 points)
Question 3- Two Forms Correctly lists 2 forms Correctly lists 1 form Does not answer
(10 points) (5 points) question (0 points)
(50 points)
Part 2
Fills out form correctly Aspects of form are Does not fill out form
and in full using case missing (0 points)
Safe Harbor Form scenario information (25 points)
(50 points)
(50 points)
©2020 UT Arlington College of Nursing 2
