Assingment under protest - page 2

Just curious if anyone here has ever used an Assingment Under Protest form and what was the result? What happens to these forms after you hand them in to managment and....should copies be sent to... Read More

  1. by   -jt
    Its not a hospital form. Ours come from our state nurses assoc which is our union. But you dont need an official form. You can just write a sentence or 2 on a piece of paper, date it, sign it & hand it in keeping a copy for yourself. All it is is documentation of an unsafe situation or something else you object to - like having to run to pharmacy all day 'cause the hosptial cut pharmacy messengers, or having to mop up spills off the floor 'cause housekeepers have been cut. All the stuff that takes you away from the pt & interfers with your being able to provide quality care. Its documentation that you informed the hospital of problems and if they chose to allow them to pertpetuate, the fall out is on them - youre not the one left holding the bag with your license.

    Say you needed something from the pharmacy & it was taking a long time to be delivered. You call the supervisor & she tells you to go to pharmacy to get it. You will have to leave your pts & leave your colleagues short staffed while youre off the floor. Anything can happen while youre gone. You cant refuse a direct order (that is insubordination) but you can protest in writing to shift the responsibility off your license & onto the hospital. Usually just saying that are doing so will solve the problem because they dont want any written proof showing that they caused an unsafe situation & are then liable for the consequences.

    But if you have to go anyway, & have protested in writing, if a pt falls out of bed while you were gone because your unit was left short staffed & the nurses couldnt be everywhere, you and those nurses are not going to have to pay for it.

    The thing that is a kick in the pants is that some nurses are afraid the manager will be mad at them so they dont fill out our protest forms. Then when something does happen, the hospital turns right around and says "Well where is her protest form??? If she knew this was going to cause a problem, she shouldnt have accepted it & was obligated to speak up. We dont have a protest form from her on this so if we didnt know there was a problem, how could we fix it? She did not live up to her professional responsibility"

    And the nurse is blamed for poor judgement in participating in an unsafe situation & is held responsible for not speaking up to protect the pt.
  2. by   -jt
    Our protest forms are pretty powerful little documents. As long as nurses use them. Some managers will try to intimidate nurses from using them by badgering them when they do, but really we let it go in one ear & out the other. If she approved a schedule that was short staffed & didnt make the arrangements to fill the staffing holes with agency or voluntary ot ahead of time & then that shifts nurses filed a protest form on staffing for that day, the manager can yell & be mad all she wants - she will still have to explain herself & make sure she provides the proper staffing for the ratios on the unit. And if anything goes wrong because of the short staffing she let happen, its her head - not the staff RNs. There is no retaliation to nurses for filling out a protest form - its their right & obligation to do so & the hospital expects them to. But managers dont like it because its proof of their judgements & decisions which might not be so good.

    The forms dont get thrown in the garbage. They have to be answered to by the hospital. We keep copies & our union gets one. They are kept for 7 yrs. Recently at one hospital, the RN JCAHO inspector asked to see the protest forms for the year. She was surprised when the RNs had 2 full crates to show her.
    Document Document Document.....


    Copies of our forms have even been used by our city govt leaders for official research & reports on the state of healthcare here. Hospital report cards were distributed by the city to the public using info & data obtained from them. The protest forms are evidence of problems that the hospital has to address & are support for contract negotiations items & even legislative agendas.

    We can say till we're blue in the face that we are being forced to work excessive hours and take care of too many pts & that this jeopardizes the pts, but that can be disputed - until we show stacks of protest forms detailing the issue & each situation. The nurse writing the facts of her assignment speaks for itself. These documents have even been used to make our case at the state capitol & highlight to the politicians why we need a state law to ban forced overtime, for example.

    Also, they help us get hospital policiies changed when we can show with the facts, rather than just verbal complaints, that there are problems. We recently used the protest forms filed by one units nurses everyday to show they have a need for more staff there. With the evidence in those documents, staff RN positions were added to that unit.

    The hospital must respond to the issues detailed in each form because the form makes them liable. For instance, in my ICU one day, we had 2 nurses at lunch when the manger told another RN to escort a pt to CT scan with the MD. She was covering her own 2 pts & the 2 pts of one RN who was on break. She explained that if she left the unit, the RN working next to her would be the only RN on that side of the unit with 7 pts to be responsible for - our staffing ratio is 1:2. The supervisor insisted, so she filed a protest form & went & the RN who had to take responsibility for 7 pts also filed one.

    Later that week, the issue was investigated at our labor/management meeting, the supervisor was "educated" by the VP of Nursing about safe staffing & proper judgement, the entire MD staff has been "educated" that when they need to escort a pt, they are to have enough of themselves there to do it - RNs are not to be pulled from their units for this, and a new hospital policy is being written with the RNs to prevent this unsafe situation from happening again. All because the RN filed her form & forced the hospital to take the responsibility for it.
    Last edit by -jt on Nov 6, '02
  3. by   traumaRUs
    l.rae - I too work level one ER and we have travellers now for the past seven months with no end in sight.
  4. by   cokie
    at my facility these are called ADO's. assignment dispite objection. i have filled these out a few times. i have also threatened to fill them out a few times and averted a dangerous assignment. i work pm's, and can usually tell by about 5pm whether i will be able to take another admit or not. then, when i am being told that i will be taking the first admit (which is almost always the case, because i am junior, per diem, and not a member of the club so to speak), i tell the charge nurse that i will be filling out an ADO. if she says i will still get it, i call the super, and then if i get it, i fill out the ADO. doen't change getting the admit, just protects my license somewhat because i have made people aware that i'm overwhelmed. they are not allowed to persecute you for filling one out, but i use it sparingly, to improve the impact. good luck
  5. by   nur.bmb
    The main information administration looks for on the forms is "adverse patient outcomes". We also have a bargaining unit facility, and have used these forms for many years. They are looked at every month at our labor/management meetings, and the ones that get the most attention are the ones with documented patient/family complaints or adverse outcomes. We were able to increase staffing on one unit because of the large number of forms the nurses had filed with management.
    Hope this helps.
  6. by   Motivated, SN
    It is amazing to me that hospitals would rather receive "crates" of
    these forms, risk lawsuits, pay out money for agency and traveling nurses; rather than just correct the problems and be done with it. At that risk of getting blasted by some; my sons told me that if women ran this country, we would have a lot less problems. I raised 'em right. lol
  7. by   nimbex
    Having been there, now older and wiser... the best advice:

    YOU, not the manager will be giving a disposition for the court of law, then sitting on trial.

    PERIOD.

    NO one will have your back, as you swear in, and try to recall obscure events, three years ago, and it hits you....

    Thats the day we were so short, hit with admits, patients going bad, I called the manager for help and there was none. Being a good nurse, we "sucked it up" and got through, horrah! for us!". Yep it was bad, charting, not a priority, it sucked, but we did our best and cared for the patients the best we could.


    Now in court......."NOT DOCUMENTED, NOT DONE.... HERE IS THE NURSING PROCESS .... SHOW ME IN YOUR DOCUMENTATION WHERE YOU..... WHERE DID YOU STATE THAT YOU NOTICED THAT.....WHAT NO CARE PLAN?...... Lacking a care plan is negligence based on non-completion of the nursing process, which constitutes negligence, on and on, trying to defend crappy notes from a patient you can't remember"


    I'm not kidding here.... it's brutal. The hospital had to settle (up theirs for putting me in such a bad spot), and shame on me for beinig SUPER NURSE, and not putting patient care as a priority instead of my fear of retribution from management.... WHICH IS REAL!

    No I'm not paranoid, been nursing since '95, now older and wiser enough to pick my battles wisely..... if you think patient care is in jepoardy.... so is your license... know that filling out a grievance with out a union will be a battle....... know that going to a court of law, will break you.

    There is back lash, there are very few laws to protect you, as the ANA site even states that YOU MUST REFUSE even with fear of retrbution, so you're screwed doing the "right and wrong" thing.

    Having been called to court, with no back up for my multiple conversations with the manager saying it's unsafe, close beds we can't do this....... I've learned which battle's are worth choosing.

    I'm sorry, you've gone through this too, but bottom line, if you don't protect your patient, you can't protect your license. And yes in the process, if they want to find a way to get rid of you they will. ....

    You may not believe it but changing to a hospital with safer staffing is easier than looking a former patient in the eye, jury to the right, having no explanation for not refusing an assignment, and a patient has experienced harm due to the decision, because you are "super nurse"

    feeling your pain,
  8. by   OC_An Khe
    Keep a copy of all the forms that you and other RNs fill out. Then ask for a private interview with the JCAHO when JCAHO next comes around and present them with a few years worth of them. How well it will work for you is anybodies guess but it helped my situation.
  9. by   NotReady4PrimeTime
    In the province I left in August of last year, these forms are called Nursing Workload/Staffing Reports. They were created jointly by union and management to protect the nurses from the fallout of staffing shortfalls, sudden changes in acuity and census, inappropriate assignments and any other factor contributing to unsafe conditions for either the patient or the NURSE. They are supposed to be filled out whenever an unsafe situation exists, even if it only lasts 30 minutes, even if nothing bad happens, even if it's promptly resolved, etc. Any nurse on that shift may file the form, it's not left to the charge nurse (some of whom really had no problem with being three nurses short, with no NA and no clerk, or else were too afraid of the repercussions of having her name on one). Over my years there I filled out many of them. The process expects that the nurse filling out the form has discussed the situation with a supervisor and that the supervisor is informed of the intent to file a NWSR. Most supervisors will make the nurse feel like a lazy crybaby for doing it, but I usually ignored that! When working conditions on our unit had been deplorable for a long time and had repeatedly been discussed at union-management meetings without any improvement, we used these forms to back up our claims at an independent review. The committee members, all management-level nurses, were appalled at how things ran in our unit and came out with 25 pages of recommendations for improving working conditions. Of course only the cosmetic ones were carried out, and the staff continue to file NWSRs regularly. When the $#!+ hits the fan, and you've gotta know it will, having one of these forms filled out and ready to deliver will be all that stands between them and the court.
  10. by   deespoohbear
    Originally posted by Motivated, SN
    my sons told me that if women ran this country, we would have a lot less problems. I raised 'em right. lol
    You sure did!! Way to go!!
  11. by   RED_ALERT37
    AT OUR FACILTY WE USE A TRIPLICATE FORM CALLED A ADO (ASSIGNMENT DISPITE OBJECTION) THIS IS A FORM THAT WAS CREATED BY THE CNA (CALIFORNIA NURSES ASSOCITATION) WE ARE A UNION HOSPITAL AND EVEN THOUGH THE FORM IS TEDIOUS AND SEEMS LIKE A WASTE OF TIME TO FILL OUT.... IT HAS ACTUALLY HELPED IN SEVERAL CASES...

    1. IT SHOWS THE ACUITY OF THE ENVIRONMENT, UNSAFE CONDTIONS, AND THE ABILITY OF THE NURSE TO PROVIDE THE SERIOUSNESS OF OBSTRUCTED PATIENT SAFETY.

    2. ITS A WONDERFUL PAPER TRAIL THAT CAN BE USED IN SEVERAL AREAS.... ONE NEGOTIATIONS, TWO LAWSUITS, THREE HOSPITAL TRYING TO PON OFF PROBLEM ON THE NURSE ETC...

    THE FORM IS ABOUT 3 TO 4 PAGES..... ORIGINAL STAYS WITH THE UNION OR PERSON WRITING IT AND IS SIGNED BY THE NURSING SUPERVISOR IN CHARGED.

    A COPY IS TO GO TO THE RISK OR UTILIZATION REVIEW (USUALLY DISAPPEARS .... IMAGINE THAT )

    AND ONE COPY GOES TO THE PPC (PROFESSIONAL PERFORMANCE COMMITTEE ) UNION BASED TO BE FOLLOWED UP ON....

    USUALLY A SUPERVISOR WILL GET VERY DEFENSIVE WHEN APPROACHED WITH THIS FORM, AND WILL ATTEMPT TO AVOID IT AT ALL COST.... NEVER EVER BACK DOWN... YOU CANT BE FIRED FOR PROVIDING A SAFE ENVIRONMENT FOR YOUR PATIENTS... AND IF YOU DO GET FIRED I WOULD GO PUBLIC AND ALSO HIRE A LAWYER..... HELLL YOU MIGHT OWN THE HOSPITAL AND BE ABLE TO RUN IT RIGHT !!!!! HAHAHAHAA
  12. by   -jt
    Just got a new one from the United American Nurses national RN union (UAN) which my state assoc is part of. Document Document Document. It goes to the person doing the unsafe assigning, a copy goes to the VP of Nursing, one to the nurse delegate, one to the union office, and the RN keeps a copy for herself. JCAHO has been asking to see them during inspections so we keep them forever. Our state assoc, which is also our local union, keeps their copies for at least 7 years because they can be used as evidence in court for a nurse's defense should something go wrong when she was forced to accept a potentially unsafe assignment:

    http://www.uannurse.org/uan/img/ADO1PRN.doc

    Assignment Despite Objection

    Date & Time: _________________________________
    Facility: _________________________________
    Shift: _________________________________
    Unit: _________________________________

    In accordance with the American Nurses Association National Code of Ethics for Nurses and my obligations as a patient advocate, I am objecting to my work assignment as:
    _ Charge Nurse _ Staff Nurse _ Float Nurse
    _ Other: ____________ .
    I have notified (Name)______________________________, (Management Position)____________________________ that in my professional nursing judgement I am unable to assure the delivery of safe or adequate nursing care because of the following condition(s):

    * Personnel assigned lack sufficient orientation
    _ Self _ Other Assigned Staff

    * _ Inadequate staffing for existing patient acuity

    * _ New patients transferred or admitted to unit without adequate staffing

    * _ Assignment posed potential of harm to health and safety of patients (explain below)

    * _ Assignment posed potential for harm to health and safety of myself or other nursing staff (explain below)

    * _ Inappropriate mix of providers (RN, LPN, NA, UAP/Tech, Clerical, other)

    * _ Inadequate or unsafe equipment (explain below)

    * _ Forced to work beyond scheduled tour (involuntarily)

    * _ Other situation:
    __________________________________________________ __________________________________________________ _

    Explain/Describe Conditions:
    __________________________________________________ __________________________________________________ __________________________________________________ ___

    CONDITIONS & WORKLOAD SUMMARY

    Unit Staff Assigned: RN ___; LPN ___; NA ___;
    UAP/Tech ___; Clerical ___
    Charge RN taking patients? Y/N #? ___
    Outside Staff Assigned: RN ___; LPN ___; NA ___;
    UAP/Tech ___; Clerical ___;
    (Utilized as:___________________ )
    Source of outside staff: Float from another unit ___;
    Intermittent or Float Pool ___;
    Agency/Fee Basis ___
    Describe Assignment:
    __________________________________________________ __________________________________________________ __
    Supervising Others?: Y/N ___
    Starting Census:____

    Describe Acuity:
    __________________________________________________ __________________________________________________ __________________________________________________ ___
    Ending Census: ____

    Describe Acuity:
    __________________________________________________ __________________________________________________ __________________________________________________ ___

    Admissions/Transfers In - Pending: ___
    Discharges/Transfers Out - Pending ___
    Admissions/Transfers In - Actual: ___
    Discharges/Transfers Out - Actual: ___
    Other workload indicators: __________________________________________________ __________________________________________________ __________________________________________________ ____

    I indicate my acceptance of the assignment despite objection; I will, despite objection, attempt to carry out the assignment to the best of my professional ability. It is not my intention to refuse to accept the assignment and thus raise questions of meeting my obligations to the patient or of my refusal to obey an order, if such were given.

    However, I hereby give notice to my employer of the above facts and indicate that for the reasons listed, full responsibility for the consequences of this assignment must rest with the employer.

    Copies of this form may be provided to appropriate state and federal agencies.

    (Nurse's Signature) _________________________

    (Nurse's Printed Name) _______________________

    Supervisor's Acknowledgment Signature: _________________________________
    Date & Time ___________________

    SPECIFIC NEGATIVE PATIENT OUTCOMES
    check all that apply:

    _ Compromised Safety/Injury; _ Death; _Delayed/Postponed/Omitted Treatment; _ Delay of Medication;
    _ Inadequate Observation/Monitoring; _ Delayed/Incomplete Documentation; _ Incident Report(s) Filed;
    _ Delayed/Omitted Education/instruction; _ Delayed/Omitted Hygiene; _ Omitted Psych/Social Support;
    _ Other (Spec(fy): __________________________________________________ ________________________________________________


    copies can be downloaded & printed at:
    http://www.uannurse.org/uan/img/ADO1PRN.doc
    Last edit by -jt on May 22, '03
  13. by   NotReady4PrimeTime
    Originally posted by -jt
    Just got a new one from the United American Nurses national RN union (UAN) which my state assoc is part of. Document Document Document. It goes to the person doing the unsafe assigning, a copy goes to the VP of Nursing, one to the nurse delegate, one to the union office, and the RN keeps a copy for herself.
    I like this form. It's similar to the Nursing Workload/Staffing Reports used in most facilities in Manitoba. It really captures the situation clearly and delineates the reasons why inappropriate staffing levels are so dangerous.

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