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RNs in Motion » 19 Collective Advocacy PATIENT ADVOCACY— OUR GUIDING PRINCIPLE The Union and Patient Advocacy RNs have independent ethical and professional obli- gations, and therefore a right as patient advocates to initiate actions that, in their independent judgment, are necessary to protect patient safety and health — even if these actions might be contrary to their employer's directives. Having a union gives nurses the legal authority and the foundation for engaging in patient advocacy on a collective basis with a unified union voice. The Right to Bargain on Patient-Care Issues There are many examples of management decisions to restructure or redesign patient-care delivery methods, including changes in staffing skill mix, abandonment or modification of acuity systems, introduction of new technologies, and imposition of new responsibilities for RN clinical supervision of unlicensed personnel. These decisions can severely burden RNs and pose significant risks of harm to patients. These same decisions are mandatory subjects of bargaining under the National Labor Relations Act and public employment labor laws. The reason they are mandatory is because they directly affect RN workload and job responsibilities, and may actually jeopardize an RN's license by preventing competent performance of professional responsibilities. The Tools Active RN participation gives power to the legally man- dated consumer-protection role of licensed registered nurses and creates the opportunity to influence the systemic changes that are at the root of the decline in quality care. RNs can promote patient advocacy on a facility level using the patient care protection tools negotiated into our contracts, which typically include the Professional Practice Committee (PPC), the Assignment Despite Objection (ADO) form, and the following: Staffing-Ratio Protections — Staffing plans are negotiated into contracts to protect against future attacks. Disputes over staffing are settled by a neutral third-party arbitrator. Zero-Lift Policies — Contract language to ensure safer lift policies, including "appropriately trained and designated staff" to assist with patient handling, available 24 hours a day. Technology Won't Replace RN Judgment — Precedent- setting language that prevents new technology from displacing RNs or RN professional judgment. Floating-Policy Improvements — Floating not required outside the RN's clinical area, and no floating allowed unless RN is clinically competent. Ban on Mandatory Overtime — Prevents nurses working when they are exhausted, which protects patients. Resource RNs — Nurses who are not given a patient-care assignment or counted in the patient acuity mix are available to assist as needed on their units.