Issue link: https://nnumagazine.uberflip.com/i/117852
Talk is cheap, write it down The ADO is a powerful tool to fix staffing Does this sound familiar? It���s Christmas Eve and you���re working the evening shift in the coronary intensive care unit. There are nine patients, but only ���ve of you. One patient is on medically ordered direct observation, another patient from the cath lab requires near constant care, and a third has a post-coronary artery stent insertion. All three should really have an RN dedicated solely to their care. So then which of you will get stuck with three critically ill patients, or another patient on top of the one who should have a 1:1? You know such an assignment jeopardizes not only the patients, but your license and livelihood. So what do you do? This untenable situation could have unfolded almost anywhere across the country, but it actually happened in 2009 at John H. Stroger Hospital, the main facility of Chicago���s Cook County Health and Hospitals System, one of the country���s largest public healthcare systems. Years before, the Stroger nurses, when confronted with an unsafe patient assignment, might have just suffered through the shift without saying anything and prayed that no one died on their watch. Or they might have called the nursing supervisor to object, to which the supervisor would have invariably said, ���Do the best you can��� (or worse). But now the RNs had one more thing they could do. They documented the incident. They ���lled out an ADO. ADO stands for the assignment despite objection form and, when used consistently and throughout the hospital, can be an incredibly powerful tool for nurses to combat short staf���ng and dangerous working conditions. Tailored to the laws of each state, ADOs provide a written account of a situation that you, as a registered nurse, objected to because, in your professional judgment, it was unsafe. The situation can be too many patients or being ���oated to a unit where you have no expertise or feel rusty in your skills. The RN keeps a copy, the hospital receives a copy, and the union gets a copy to use in collecting data to spot trends and patterns. The ADO form is admissible in court and may be the only proof an RN has that she or he warned management about unsafe conditions in case something goes wrong with the patient. In states with staf���ng ratios laws and facilities that have minimum ratios written into their contracts, ADOs are critical for enforcing those standards. In recent years, NNU facilities have also introduced the technology despite objection (TDO) form to document instances where hospital health information technologies have posed barriers for RNs in providing safe care. In the case of Stroger Hospital, the RNs there were in the middle of an ADO drive. After joining the National Nurses Organizing Committee in 2005, nurses were introduced by the union to the ADO form. But it was a new thing and RNs were not regularly ���lling them out because they didn���t understand how powerful of a tool they could be in ���xing staf���ng issues. In 2009, Stroger RN and professional practice committee member Dorothy Ahmad and PPC chair Jim Safrithis, RN decided to start an ���ADO drive��� to educate their colleagues about how to use ADOs. They put together a PowerPoint slideshow to show RNs how to ���ll out the form and began presenting it every chance they got.