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Patient Protection Toolbox As rapid changes are implemented in health care settings, RNs often witness unsafe or compromised patient care conditions. Advocating for safe, ther- apeutic, and effective care for your patients is one of the most important activities that you as a regis- tered nurse can undertake to protect yourself and your patients. In fact, the California Code of Regu- lations under Title 16 requires RNs to act as patient advocates. CNA/NNU contracts provide important tools for protecting patients and your license in these situations: Assignment Despite Objection Form One of the first steps in the advocacy process is documentation. Fill out Assignment Design Objec- tion (ADO) forms every time you and coworkers are given an unsafe assignment. Remember, an unsafe assignment may simply be one where you were unable to provide all the care that each patient needed in a timely manner, while allowing you appropriate rest and meal breaks. An assignment does not have to involve a sentinel event to be unsafe. Encourage your coworkers to fill out ADO forms when appropriate. Try to have everyone on the shift in question sign the form. There is strength in numbers. The Professional Practice Committee at Your Facility The PPC is a staff RN-controlled committee, nego- tiated into every CNA/NNU contract, with the authority to document unsafe practices and the power to make real changes. Direct-care RNs elect representatives from every major nursing unit to serve on the committee, which meets in the hospi- tal on paid time. The PPC tracks unsafe conditions utilizing ADOs. The PPC discusses practice and staffing problems on various units by analyzing the ADOs for trends and recurrent issues. Information requests are submit- ted to management as needed, to assure that the committee has all the facts that might be useful in crafting a solution. As a PPC member, you may also elect to report the problem to the appropriate regulatory agencies. RNs and others who blow the whistle on unsafe patient care to outside sources are protected from retaliation under California state law and by the contract. In the 1999 legislative session, the Cali- fornia Whistleblower Protection Act, sponsored by CNA, was signed into law. If a nurse is fired within 120 days of report- ing unsafe conditions, the law provides that the employer must bear the burden of proof to show that the firing was not retaliatory. New whistle- lower protection provisions are included in CNA/NNU's hospital patient protection acts that are now being introduced in several states and nationally. Patient Advocacy— Our Guiding Principle Collective Advocacy 28 RNs in Motion