National Nurses United

J A N U A R Y | F E B R U A R Y | M A R C H 2 0 2 6 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 15 " Y ou have to fill out the ADO, otherwise patient care is compro- mised," says Michelle Kubota, an RN for 25 years at Seton Medical Center in Daly City, Calif. "The ADO is very important to protect your license. Manage- ment or the supervisor will know that you are protesting that the assignment isn't safe for your patient or your license." Anna Lendabarker, RN at UChicago Medicine wholeheartedly agrees. "ADOs are a great resource to document any staffing or safety issues that come up," says Lend- abarker, who has worked at UChicago since 2013. "In Illinois, we don't have a ratios law, but the ADOs protect the staff and are a real-time documentation of issues that are going on with the hospital." The Assignment Despite Objection (ADO) is an independent documentation system that the Professional Practice Committee (PPC) uses to track and docu- ment unsafe conditions—everything from short staffing and missed breaks to unsafe floating and more. The PPC, an elected committee of staff registered nurses repre- senting every major nursing unit, has the power to document unsafe practices and make changes. When nurses fill out the ADO—a four-part carbonless form—the top copy goes to the supervisor, the second copy to the PPC, the third to the labor representa- tive, and the bottom one is retained by the nurse or group of nurses who fill it out. "We have a pretty robust culture at UChicago to utilize ADOs," notes Lend- abarker, who is the ADO chair of the PPC at UChicago Medicine in Chicago, where National Nurses Organizing Committee represents about 3,000 nurses. "We routinely get 100 to 200 ADOs a month. I encourage everyone to submit ADOs as a group because typically if one person's assignment is inappropriate, that's also the case for others." When one nurse in a unit can't take a break, that usually affects the entire unit, says Tinny Abogado, RN in the step-down unit and chief nurse representative at Kaiser Permanente Los Angeles Medical Center (LAMC), where California Nurses Association (CNA) represents nearly 1,300 RNs. "We fill out the ADO as a group so there is less fear of retaliation," says Abogado, who has worked at Kaiser LAMC for 24 years. "Each nurse prints their name and adds their signature." "If you complete the ADO and the supervi- sor doesn't resolve the issue, it's documented," notes Kubota, PPC chair at Seton, where CNA represents nearly 300 nurses. "The details on why you think it's an unsafe assignment and how patient care is affected is in the ADO." If a nurse is accused of missing some- thing or making a mistake, they can pull out the ADO for that date and show concrete documentation that reports what was happening that day, such as short staffing, and how that affected patient care. Accord- ing to Reanna Felix, an RN in the emergency department at Seton, people on her unit who made a med error have been saved by the ADO. Felix says they didn't get in trouble because the ADO showed the shift was understaffed and they were busy with other patients. Romina Legaspi, a criti- cal care RN and PPC chair at Kaiser LAMC has a similar example of a nurse who was facing corrective action, but because he filled out an ADO, he was able to show that it was short staffing, not negligence, that created the issue with the patient. "With the ADO, you have a good rebuttal," says Legaspi. "The ADO made a big difference for the nurse." "The ADO is a document that can stand up in court. It can literally protect you if you are taken to court," says Fran Alexanderson, an RN in the hematology/stem cell trans- plant unit and co-chair of the PPC at City of Hope in Duarte, Calif., where CNA repre- sents 1,700 nurses. An ongoing series The Power of the ADO Documenting unsafe conditions protects your license and your patients By Chuleenan Svetvilas Anna Lendabarker, RN Fran Alexanderson, RN

• Cover