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ADO forms--not a blame game.

Many of you are familiar with assignment despite objection (ADO) forms. This is a document which a nurse completes when s/he has been given an assignment they feel is unsafe for some reason. The nurse is accepting the assignment, though objecting to it. At times, in the beginning of a shift, all is seemingly well and then some part of the dynamic changes and everything falls apart--especially on night shifts when there are less overall resources available. This is often the point when an ADO form is generated by a nurse. Completion of the ADO form should go hand-in-hand with telling the supervisor that you feel the assignment is unsafe and asking for assistance. At times, there is really nothing more that can be done to rectify the situation, i.e., the supervisor has already called everyone on the list and there are, plain and simple, no nurses available to come in and help (though perhaps a nurse from another unit can be pulled to come and assist even for a short period of time.)

When a nurse completes an ADO form, s/he is not blaming the supervisor or the healthcare facility; s/he is simply documenting a problem and/ or an unsafe situation. Even in the aforementioned situation, an ADO should still be completed, even though the parties know measures were employed in an effort to fix the problem. This action protects both the facility and the nurse in case of an untoward event.

Submitting an ADO is a form of concerted activity and is a protected activity under the National Labor Relations Act. All nurses represented for collective bargaining have the legal right to document when they feel an assignment is unsafe. Some supervisors attempt to dissuade nurses in their units from completing ADOs feeling it reflects badly on them. This is counterproductive; it is a shared responsibility for nurses and administration to partner together for better, safer patient care on each and every shift.


What happens to an ADO once completed? In most facilities, three copies are disseminated. One copy goes to the Union President; one copy to the Chief Nursing Officer (CNO) or immediate supervisor, and the nurse completing the form keeps the original. The supervisor or CNO generally investigates the incident evaluating the staffing plan, unforeseen circumstances, and the problem-solving that took place at the time in an attempt to make the situation safer. The investigation is usually documented by a member of the management team depending on the structure of the facility.

Then what? In most facilities where the nurses are represented for collective bargaining, there is a structure or mechanism for facility leadership and union leadership to formally collaborate on a regular basis. In some facilities, this is known as a Labor-Management Committee or the Professional Conference Committee. In either case, a discussion ensues between the parties. In some facilities, the nurse who completed the form will be invited to the joint committee to present and discuss their ADO. In other facilities, the Conference Committee reviews the form on their own. The situation which resulted in the ADO is examined in-depth. In some cases, the committee evaluates the circumstances and the group reaches consensus and determines nothing different should have or could have been done. In other situations, perhaps the group would recommend a different problem-solving measure be employed. In either case, there is no score card for rights and wrongs. This process is all about providing safe patient care and learning from past experiences.

Amy Hauschild RN, BSN
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Author:Hauschild, Amy
Publication:The Pulse
Date:Nov 1, 2011
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