Question. What is ADO form?
Answer. A Staffing Complaint/ADO is a form that documents a good faith effort on the part of a nurse to call attention to problems that affect nurse and/or patient care, safety, or satisfaction. The goal is to fix these problems and ensure they don’t reoccur. Filling out and filing an ADO form may protect you one day if ever an untoward outcome should occur with yourself or a patient.

Q. Why should I fill out ADO forms?
A. Staffing Complaint/ADO forms provide documented evidence that a problem exists on a unit and initiates a process for improving the situation. Once management has been presented with an issue, it is incumbent upon them to address it. Additionally, you are documenting the facts, which may be helpful to you if there is a negative outcome. The submitted Staffing Concern/ADO also provides the Staffing Committee members with specific details, rather than with anecdotal examples about staffing complaints, and helps them determine if a complaint has been resolved or not. The Staffing Committee has the legal responsibility to determine if staffing complaints are resolved or unresolved. Complaints that show an unresolved trend for 60 days or more could result in an investigation by the Department of Health and possible fines. When appropriate, some complaints may be taken to Conference Committee by our WSNA Local Unit officers to try to resolve the concern.

Registered nurses have the responsibility to report when care is unsafe. If unsafe situations go unchecked, those we serve may be put at risk, and you put your RN licensure at risk.

Q. ADO when and how?
A. If you feel your situation/assignment is unsafe, you need to report it to your charge nurse or manager as soon as possible and go up the chain of command if time permits. Please do not simply reject the assignment because this may be viewed as being insubordinate. If the situation is not immediately addressed/remedied by Management, you need to fill out and file an ADO form as soon as you can. Also, it may help to think of completing an ADO form as an S.O.S. – Short on Safety, Short on Supplies, Short on Staff. Be detailed in your description of the issue/concern and please complete the form and ask other nurses who were affected complete one as well

Q. Where do I find this form?
A. You can find WSNA ADO forms by going to http://www.wsna.org/ado.

Q. Who can fill out this form?
A. Any nurse that is covered under our contract.

Q. Will my manager or I get in trouble if I fill out this form?
A. This form is not meant to get anyone in trouble or penalized. This form is intended to help out the staff and surface concerns. It is actually illegal to retaliate against any nurse for submitting any complaint related to staffing. If any nurse feels they are being penalized or retaliated against by their manager for filling out an ADO, please let any of your officers or Travis Elmore know.

Q. Can you provide examples of when it would be appropriate for me to submit an ADO?
A.

• Your unit is not staffed according to its staffing plan.
• Shift adjustments to staffing are inadequate.
• 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
• You are not trained or experienced in the area assigned, or have not been oriented to this unit / case load
• Necessary equipment is not available (supplies, IVs, medication availability), or you are not trained or experienced to use equipment in assigned area
• An assignment poses a threat to the health and safety of a patient under your direct care
• Coerced/Mandatory overtime, or missed breaks

Q. What happens with the form once it is completed?
A. Please enter your manager’s E-Mail address so that they get a copy. Once submitted, you, your local unit chair, WSNA rep and staffing committee leaders are automatically copied. This form will be presented at the next hospital staffing committee meeting or nurse conference committee meeting.

Q. What if I have a question? Who do I contact and is there a time line?
A. Email one of your officers or Travis Elmore WSNA Rep. If you can give us the form within 48 hours of the actual incident, that would be helpful.

Again, our WSNA/PeaceHealth St. John contract and the law both prohibit retaliation against nurses for filing a Staffing Complaint/ADO

Do you want to make a difference for your coworkers at PeaceHealth St. John Medical Center?

Help shape your workplace culture by becoming a Grievance Officer!

Grievance officers go with RN’s to meetings with management and support RN’s should they choose to file a grievance.

The time commitment is approximately 4-6 hours a month but the impact on the lives of your fellow RN’s is enormous!

To learn more about how to become appointed as a grievance officer, contact your WSNA Nurse Representative!

Questions? Contact WSNA Nurse Representative Travis Elmore at Telmore@wsna.org or 206 -575-7979, ext. 3117.