National Nurses United

"I started filling out ADOs from Day 1," says Felix, who began working in March 2025 when the ED was chronically under- staffed. "My parents have been nurses for 25 years. My mother told me about the impor- tance of filling out ADOs." When Felix first began working at Seton, ED nurses had not been filling out ADOs due to the manager's lack of response, but Felix reminded them, "You don't want to lose your license. You never know when you'll need the ADO." Her example and encourage- ment worked and now ED nurses regularly fill out ADOs as needed. They fill them out as a group. Felix also staples the ED staffing sheet to the ADO, which shows just how short staffed that shift was. As a result of ADOs and a petition of no confidence in the ED manager, staffing has improved. The ADO is how nurses hold manage- ment accountable. If management does not resolve the problems during the shift and if it is an ongoing or egregious issue, the PPC can directly address it with management at a PPC meeting. Some issues can be resolved more quickly than others. To be sure, some nurses may wonder why they should continue filling out ADOs when manage- ment is slow to respond, but ADOs are very helpful for identifying trends, providing extremely useful data in contract negotia- tions. This is why it is crucial to continue filling out the ADOs: The data will show management that the issues are ongoing and need to be addressed or patient safety remains at risk. Without documentation, the conditions will not change. ADO data was critical during City of Hope contract negotiations in 2024. The nurses brought a giant stack of ADOs and gave a presentation about why they needed resource nurses to provide break relief. They were able to show that in 2023, RNs filed 846 ADOs, documenting their concerns with unsafe staffing and missed meal and rest breaks, reporting that 92 percent of the ADOs cited inadequate staffing as the reason for filling out the form. The result? The RNs won resource nurses for all inpatient units in the four-year contract they ratified in June 2024. UChicago nurses also find ADOs very effective during contract negotiations. The nurses come to the table with what Lendabarker refers to as their ADO "moun- tain," stacks of huge file boxes stuffed with ADOs. The ADOs were key to the nurses' last contract negotiations. They won a dedicated meal- and break-relief nurse in the adult emergency department and a commitment that charge nurses will not be assigned a patient load in nearly a dozen new units. Missed meal and rest breaks were also a big issue for Kaiser nurses at their last contract negotiations in 2022. "Nurses were so pissed off about management just deny- ing lunch breaks and not even attempting to rectify that," recalls Monte Wright, RN and PPC member at Kaiser San Jose in San Jose, Calif. "They said, 'We'll just pay the penalty.'" Management was not listening to the nurses so they wanted to show them what was going on. The Kaiser San Jose nurses met in the cafeteria to tape together about 600 ADOs into one very, very lengthy piece of paper to protest short staffing. "We were holding this long document that snaked through the hallways, past administration offices, and out to the front door of the hospi- tal," says Wright, who has worked at Kaiser San Jose for 17 years in the perioperative unit. "It was unforgettable and so powerful. We were able to get language in our contract surrounding meal-and-break relief." The hundreds of ADOs got their atten- tion. "ADOs act as leverage to get your point across," says Wright. "Sometimes we will just walk about with the form and management will run to fix the problem." Chuleenan Svetvilas is a communications specialist at National Nurses United. 16 N A T I O N A L N U R S E 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 J A N U A R Y | F E B R U A R Y | M A R C H 2 0 2 6 Michelle Kubota, RN Above: Thousands of ADOs filed by UChicago RNs.

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