Staffing Complaint / ADO Form

Complete the online form and your WSNA Nurse Rep, Staffing Committee, and Local Unit Chair / Co-Chair will be notified immediately.

If you find yourself in a situation that you believe creates unsafe conditions for patients or for you, complete the Staffing Complaint / ADO (Assignment Despite Objection) form as soon as possible.

By completing the form, you are helping to make the problem known to manage­ment, which creates an oppor­tu­nity for the problem to be addressed. Addition­ally, you are documenting the facts, which may be helpful to you later if there is a negative outcome.

Types of situations where you should complete a Staffing Complaint / ADO form:

• Charge nurse is unable to perform charge nurse duties, secondary to increased patient care assignment
• Inade­quate nurse to patient ratios for patient acuity based on your clinical judgment
• Insuf­fi­cient support staff requires you to assume additional duties
• You are not trained or experi­enced in the area assigned
• You have not been oriented to this unit / case load
• Patient care equip­ment missing or unusable
• Neces­sary equip­ment is not avail­able (e.g.: supplies, IVs, medica­tion availability)
• You are not trained or experi­enced to use equip­ment in assigned area
• System failure (e.g.: computer, phone, pyxis, call system)
• An assign­ment poses a serious threat to your health and safety
• An assign­ment poses a serious threat to the health and safety of a patient under your direct care
• Forced / manda­tory overtime
• Missed breaks