What can you do if you feel your assignment is unsafe?

Over the past few weeks, we’ve had a lot of nurses reach out telling us about their unsafe assignments. Nurses working this last weekend started their shift at 0600 and discovered there was no supervisor in the house and only a single charge nurse to support the facility. We have amazing charge nurses, but we feel ability shouldn’t be an excuse for poor staffing. The question is, should nurses have to run the whole house without a supervisor around for backup and/or distribution of duties?

Our answer is NO- A charge nurse should not have to be the only staff support for the whole house without a supervisor. Our staffing plan calls for 2 charge nurses for every shift. When the charge RN is placed with that much responsibility it can make it difficult for a bedside nurse to ask for help. They don’t want to burden the only charge nurse. We are a team at St. Lukes’s and nurses can recognize when another nurse is stretched too thin.

What can you do to help?

File an ADO (assignment despite objection) aka unsafe staffing form. If you find yourself in a situation that you believe creates unsafe conditions for patients or for you, complete the Staffing Complaint / ADO form as soon as possible.

By completing the form, we are helping to make the problem known to management, which creates an opportunity for the problem to be addressed. Additionally, these forms document the facts, which may be helpful to you later if there is a negative outcome. We can even back date ADOs, though we strongly suggest filling one out as soon as possible.

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

Please help spread the word. Nursing staff shouldn’t have to work short staffed.

You can also find QR codes on your blue WSNA badge buddy that link to ADOs, your local unit page, and membership applications.

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

No one, including the supervisor, is allowed to discourage you from filling out an ADO. You do not need to ask permission to fill out an ADO. We strongly encourage all nurses to escalate issues in real time to their ANM, supervisor or charge nurse and to follow the chain of command if it's not resolved. However, escalation is never a requirement to fill out an ADO. Please report any concerns surrounding these issues to your nurse rep and/or one of your local unit officers.

What happens next?

You have now brought up your concern to the ANM, supervisor or nurse in charge. You have filled out the online form. In the best-case scenarios, your supervisor is able address and fix your concern. Maybe they were able to call in extra nurses or support staff to work on the floor. Maybe they found you a working IV pole or gave you a much-needed break. In any case your ADO will also be addressed at the monthly Hospital staffing committee meeting. This committee is made up of members of administration, management, nurses, nacs and your WSNA Nurse Rep Alle Machorro.

During this committee meeting the parties in attendance address every single ado that has been filed in the previous month. This allows the team to address concerns as well as recognize patterns in staffing and resources. By speaking up you can be a part of positive change.

Some common questions:

Are nurses allowed to attend Hospital staffing committee and speak up about their ADO? 
YES. We highly encourage this option if you can make the time work in your schedule. Sometimes the issues aren’t crystal clear. Be sure to provide as much detail as possible when filling out your ADO.

Will I get in trouble for filling out an ADO? 
No. You should not and retaliation in any form in unlawful. If you feel you have been retaliated against for using an unsafe staffing form, please contact a local unit officer or WSNA Nurse Rep, Alle Machorro.