Assignment Despite Objection Form

This looks great. Texas State Board has a similar form called "Safe Harbor", when it's called and filled out it is supposed to offer protection to the nurse who has raised a concern. I don't have personal knowledge of how that has worked out if the worst happened (poor outcome due to safety concerns).

I do know that at the facilities I have worked at, threatening to call "Safe Harbor" usually produces some kind of result. Mostly because it's a ton of paperwork for the hospital and they must undergo peer review if the process is actually initiated.

I have seen a few versions of this type of document. It may work in a few states, but i would guess that in most it may as well say "Please Show me to the Door Before my Trouble Making Ways Spread to Others".

We used a similar form in my old job in NYC. It was called the protest of assignment form. People would still take the assignment, but where it becomes useful is if a bad outcome or event occurs, it should save you from personal responsibility and the hospital management will really have some big explaining to do. I think its great. Most hospitals in NYC have nursing unions, so there is no way someone could get fired for that.

This form was used at the hospital I had my last assignment at. It didnt get people in trouble. It was more of an internal communication, sending a message that something went wrong and the pt. load is not ideal for PG scroes and safety.

Of course, as with everything, there are those who abuse it and it turns into something else.

We also use a protest of assignment (POA) form in my union. The professional association cautions nurses who are not covered by the union that using the form may put their job at risk.

Our form states that the nurse is notifying management that the assignment is unsafe. There is a place on the form where the nurse can indicate whether she is accepting or refusing the assignment. I have seen situations where the nurse has refused the assignment and still kept their job- but I wouldn't think this is possible without a union behind you.

My contract provides the process that must be followed:
-the nurse must notify management that they are protesting the unsafe assignment
-management must respond either in person or by phone if unable to get to the unit
-management must sign the form (then copies go to the union, administration, and the nurse keeps one)
-POAs are reveiwed and discussed by the union and management
-a nurse cannot be discouraged from filling one out or suffer any reprisal for doing so

Ultimately, the nurse is responsible for the care they give, but my state board of nursing has put in writing that they will consider the circumstances if there is a practice issue that arises during the carrying out of such an assignment and the nurse had submitted a POA at the time. So, the POA does offer some protection here.

It also helps management share in the responsibility for the given situation. In my state, inappropriate delegation of an assignment to an RN is considered misconduct by the BON.

We also use the information from completed POA forms when negotiating for staffing and lobbying legislators for staffing ratios.

It should be illegal to retaliate against a nurse for reporting unsafe conditions.

The form is your proof that you notified your employer that your judgment is that the assignment is unsafe. It then becomes the employers’ responsibility to act to change conditions such as shore staffing or floating you to care for patients you are not competent to care for.
Any adverse consequences of their failure to act is the responsibility of the employer NOT the nurse filling out the form.

Just a couple of thoughts: Obviously, these are most helpful and effective in a unionized environment, where the nurse has that sort of support and protection.
And even in a unionized environment, they work best in a coordinated campaign to protest a recurring unsafe practice. We've done organized campaigns where there was a floor that was recurrently getting out of safe ratios, etc, getting every nurse to fill one out every time things went over the line. This has two benefits - keeps any one nurse from being targetted as a troublemaker, and builds a really impressive looking paper trail that starts to make managers very nervous. Tends to get results.

An ADO ( or equivalent ), gets attention usually because it documents a patient care deficiency , it transfers liability to the facility and it is a discoverable document ( in case of legal action , it has to be disclosed , wheras many other facility forms are simply internal documents to cover the facilities R's)

I hope that the nurses are making copies of these forms in case they "mistakenly disappear". You know how that happens.
JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN
Spokane, Washington