Assingment under protest

-jt · May 21, 2003

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

Pediatric Critical Care Columnist · May 21, 2003

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.

pickledpepperRN · May 21, 2003

Some sites about the form called Assignment Despite Objection (ADO), Disclaimer, or Assignment Under Protest. I would suggest also sending an incident report to QA & Risk Management. Include the staffing whether or not you know about a real incident. They should know about unsafe situations (staffing). If you delayed charting include that by the end of your shift you could not remember everything so documentation was incomplete. Give the ADO to a manager and keep one for yourself.

If all the staff signs it I doubt there will be retaliation. Ask the loudest complainers to sign first. Others will likely go along with their co workers.

http://florenceproject.org/ado.shtml

http://florenceproject.org/adodisclaim.shtml

http://www.calnurse.org/np/muchado10802.pdf

http://cna.igc.org/cna101/nursingpractice.htm

http://www.calnurse.org/np/adohelp.pdf

The Florence Project form:

ASSIGNMENT DESPITE OBJECTION

________________________, a registered nurse employed at ________________________Hospital on _______(shift), _______(unit), hereby object to the assignment as:

___charge nurse ___primary nurse ___team leader ___team member/patient care assignment made to me by __________________(supervisor) at _______(time) on ________(date) despite my objections on the grounds that I was: (check appropriate description)

a)___not oriented to the unit

b)___not trained or experienced in area assigned

c)___given an assignment which posed a serious threat to my health or safety

d)___given an assignment outside my current job description

e)___case load assignment is excessive and interferes with delivery of adequate patient care

f)___not given adequate staff for acuity (check appropriate description)

___staffed with excessive registry personnel

___staffed with unqualified registry personnel

____staffed with excessive number of unlicensed personnel

___short staffed

___not provided with unit clerk

g)___transferred or admitted new patient(s) to unit without adequate staff

e)___other: (please specify)________________________________________

_____________________________________________________________

This assignment is accepted because I have been instructed to do so, despite my objections.

STAFFING COUNT on date of objection:

regular float/casual registry/agency staff currently employed on unit

RN____________________________________________________

LPN___________________________________________________

AIDE__________________________________________________

Unit Clerk yes__ no__

CENSUS (on date of objection): ACUITY: high average low (circle one)

Number of patients on unit___ Unit capacity___

Brief statement of the problem:_______________________________________________

______________________________________________________

ACTIONS TAKEN BY NURSE:

Notified Head Nurse:___________________time_______date___________

Notified Nursing Supervisor:______________time_______date___________

Notified Doctor________________________time_______date___________

Back to The Florence Project's Main Page

This page was last edited on Monday, 06-Sep-1999 01:00:00 PDT.

daynurse · Jun 6, 2003

What right to protest reassign. form. There is no such form in my facility. Our policy states nurses refusing reassignment will be suspened or terminnated.

webbiedebbie · Jun 6, 2003

I'm not sure, but I think the point is that if there is unsafe staffing, these forms will benefit us. It's true, you can't abandon your patients. This may be the only way to bring understaffing or floating to a unit where you are unfamiliar with that type of nursing care to administration's attention. We nurses have to protect ourselves as well as the patients we take care of. If there is not enough staffing, our patients could be harmed. Administration only looks at numbers and money. They demand quality of care, but do not always provide it.

pickledpepperRN · Jun 6, 2003

Originally posted by daynurse
What right to protest reassign. form. There is no such form in my facility. Our policy states nurses refusing reassignment will be suspened or terminnated.

In the event there is harm to a patient because staffing was unsafe or you were floated to care for patients whose age or diagnosis you were not competent to care for the form could save your license. You could be dropped from a lawsuit. It would be the responsibility of the FACILITY NOT THE NURSE if you can prove you accepted the assignment under protest.

-jt · Jun 7, 2003

"There is no such form in my facility." -

The protest form is not a hospital document. You dont get it from the hospital. Its the nurses' document. Print one of these and just start using them or just write a note to your supervisor when you have an unsafe situation that could harm your pts. And keep a copy of that for yourself as proof that you did inform her. You have a responsibility to inform your superior of any situation that could cause harm to your pt and you have a responsibility to prevent your pt from harm. You could lose your license if you dont do so & something happens to harm your pt. We have had cases where nurses felt too intimidated to write a protest, so didnt & then when a med was given late or something else happened, the RNs were disciplined not only for the thing that went wrong but ALSO for not living up to their responsibility to report a potentially harmful situation -- and the DON says "where is the protest form? You should have filed a protest form for this situation but you didnt. You failed to provide a safe environment for your pts". Even if they had told the supervisor there was a problem, if they didnt put it in writing, the supervisor can claim she wasnt told anything. If you ever get hauled into court for something that happened as a result of an unsafe situation that you can prove you informed the hospital of, and you did the best you could in the situation you were forced to work in, your putting your protest in wiriting forwarned the hospital that problems could arise and if they do nothing to fix the situation, they are the ones held responsible in court.

TreceRN · Jun 7, 2003

Don't hate me because I'm "management", but I've read these posts with great interest and would like to present the other side of this dilema. I manage a 33 bed telemetry unit in a small, 150 bed community non-profit hospital. I've worked both sides of this issue, as a cardiology and critical care nurse for 7 years, and now as a manager for 2 years. I've received three "assignment despite objections", all of them within the first 6 months on the job. I took them very seriously and investigated the circumstances of each. We did adjust our staffing guidlines based on increased acuity and increased documentation demands that are placed on our nurses, and on a daily basis I'm involved with staff and other nurse managers desperately trying to decrease the workload of nurses while still meeting documentation standards. All the while we are walking the tightrope between our "mission and margin", coping with government reimbursement cuts in Medicare and Medicaid (which is 70% of our income), staggering increases in malpractice insurance, and the ever increasing government regulations that force us to hire non-nursing support to help us stay in compliance. Like it or not, gang, if we can't make enough money to pay our bills, our doors close and we are all out of jobs! I can't speak for all nurse managers, but I can say that I spend a great deal of my time on the unit helping with admits, discharges, and transfers. No "meeting" takes precedence over my unit's needs. I work 10-12 hours a day, 5 days a week (and I'm exempt, folks, no overtime pay for me). Unfortunately, I can't always be there and I know there are still shifts when all heck breaks loose and staff want to call it quits. Believe it or not, I bet your managers are just as frustrated as you are. And contrary to the beliefs of some, we cannot pull nurses out of thin air. There really ARE times when we simply can't find one more nurse of aide! Why not cut your managers some slack, stop in and ask them how their day is going for a change. It's very easy to critize and blame managers for our current crisis in healthcare. Take it from me, this is a VERY TOUGH JOB. Walk a mile in my nurse-shoes for a day and you'll agree.

-jt · Jun 8, 2003

Watching my nurse manager spend hours on the phone looking for staff to do overtime, I know she has a hard job being stuck between a rock & a hard place. Today, she was off & another manager was covering the house. I called her in the nursing ofice 3 buildings away 15 minutes after my shift started to inform her of the unsafe situation in my ICU - which I am OBLIGATED to do. We had 7 RNs - one was a float from CCU, no nurses aide, a secretary floated from med-surg, 15 pts - 9 of them on vents, vasopressors, and/or continuous sedation and 3 pts active GI bleeds being transfused & still bleeding. 2 pts in septic shock - both requiring 1:1 care. 12 pts listed as "critical". 1 other on transfer to the floor & 2 more vented & waiting in the ER for ICU beds. When I called the supervisor to let her know the situation, she yelled at me without even letting me finish the sentence, told me she doesnt need me to tell her what the acuity is & then slammed the phone down, hanging up on me. How can I uphold the Nurse Practice Act & my license if the supervisor prevents me from informing her of a situation that can cause harm to the pts? I filled out a protest form describing all of the above & the supervisors response & sent it to the VP of Nursings office for her to deal with.

ainz · Jul 3, 2003

Please don't hate me because I am in administration. I am the Chief Operating Officer for an acute care hospital. I am not aware of such a form and don't believe our hospital provides them, therefore, you would have to type it out yourself. If one of these came across my desk, my first step would be to call the DON in and have her bring the assignment sheet, patient census, supervisors report, etc., etc., to review with me. I would have her explain why we had nurses accepting assignments under protest. I would ask this question to learn why we were expecting the nurses to take an assignment they felt unsafe about taking. Since I am a nurse and worked as a staff nurse for 15 years before going into administration, I tend to view things from the perspective of the point-of-service, that is the patient's bedside. I can tell you that situations that occur that lead a nurse to muster the courage to type up one of these forms is bad news for everyone. First, the administration probably doesn't care, actually, they do care but they care more about finances and making the numbers because their jobs are on the line as well. Some organizations would simply fire the nurse for typing such a form. It would also be ammunition to show the hospital was aware of dangerous staffing situations and would not look good if ever brought into court. It is definitely not good for the patient, it does not leave a favorable impression on the medical staff. And as far as protection for the nurse, I would not count on it. If for some reason you ever wound up in court and you were counting on this document to protect you from liability or minimize your liability, it could backfire. It may not, but it could. Another view of this that could be argued by an attorney is that you accepted the assignment anyway with the knowledge that it was unsafe for you to do so, therefore, you share in the liability. Especially if you did not follow-up with some immediate and aggressive corrective action such as notifying your supervisor, nursing director, administrator on call, and medical staff leadership so that immediate action could be taken to correct it. Reality would suggest that if you did such a thing, say on the 11pm-7am shift, you would probably be fired as well. It is a bad thing to have such a situation and attempt to place nurses in such a position. Obviously your administration is focused more on the numbers than anything else and must be desperate or greedy, or maybe both. I would seek other employment and interview the new hospital leadership as hard as they were interviewing me to make sure that you agree with their philosophy and management style. I would also suggest you ask for a meeting with senior management such as the CEO, COO, VP,etc in addition to the DON so that you can know first hand. I know this is not the usual protocol but as a staff nurse and in light of the increasing number of times nurses are put in dangerous situations, staff nurses may want to begin to ask to speak to one of these people before they accept a job. If I had an RN that was applying for a job ask to speak to me as part of their interview; first I would ask why, then I would be impressed if they told me so they can understand administration's philosophy more clearly to help them decide if they want to be a part of the organization or not. I would certainly talk to the nurse and answer any question they had. Staff nurses should begin doing this more and be careful about selecting who you go to work for. Nurses have the power, realize it, believe it, use it!!!