assignment against objection

University of Michigan Professional Nurse Council

Assignment despite objection forms, what is assignment despite objection.

As a licensed registered nurse, you have a legal and professional obligation to notify your employer of an unsafe situation so the problem can be corrected and injury or harm to the patient can be avoided.

If, in your professional judgment, you believe a patient care assignment is unsafe, or potentially unsafe, an Assignment Despite Objection (ADO) Form should be filled out.

When in doubt, fill it out!

When should i fill out an ado form, examples of when a form should be used:.

Need for additional RN or support staff (e.g., monitor tech, unit secretary) ​

Can’t reach a doctor for orders or admission

Late lunch/no lunch

Lack of training or competency to handle patient care assignment.

Mandatory overtime (being required to stay after scheduled hours)

Unsafe environment/workplace violence (hostile patient/family)

Skills mix on unit is insufficient

Forms can and should be used as often as needed and may be filled out up to 7 days after the occurrence.  ​

What do ADO forms do?

When forms are filled out, it does the following:

Eliminates administration deniability ​

Creates a historical record

Establishes a database maintained by the union

Tracks negative staffing or patient care trends

Can be used in court, before state agencies, and in legislative hearings

ADO forms protect your license!

Assignment Despite Objection (ADO) forms are admissible in court, with regulatory agencies, and are protected under federal labor law.

It is illegal for management to discipline or retaliate against any nurse for filling out a form and advocating for themselves and their patients. 

IntelyCare for Healthcare Facilities > Resources > Nurse Management > How to Manage an Assignment Despite Objection: 5 Tips for Facilities

How to Manage an Assignment Despite Objection: 5 Tips for Facilities

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Nurses are legally accountable for the quality of care they provide to patients. Under that responsibility, they must ensure that they’re competent to provide the treatment necessary for each individual assigned to their care. While most supervisors attempt to allocate patients according to each nurse’s ability, there are instances where a nurse may believe that their assignment places themselves or their patients at risk.

In these situations, it is the nurse’s duty to complete an Assignment Despite Objection (ADO) form . You may be wondering — What does ADO paperwork look like, and what are the steps required to ensure the forms are completed appropriately?

In this article, we introduce the purpose of ADO forms, review an example scenario that highlights the ADO paperwork submission process, and list five tips for facilities looking to appropriately manage ADO situations to ensure staff protection and patient safety.

What Does Assignment Despite Objection Mean?

The term “Assignment Despite Objection” is used to describe a situation in which a nurse has been made responsible for an unmanageable patient load. Despite making it clear to unit leadership that the staff member feels unsafe, unqualified, or unsupported in managing the care of that particular assignment, they have been mandated to assume care for that assignment. A nurse may complete an ADO for a number of reasons, including:

• Being assigned to care for a number of patients that falls outside of any legal nurse-to-patient ratio .
• Feeling inexperienced or untrained in a particular area or specialty.
• Experiencing a shortage of support staff that would make the assignment manageable.
• Lacking sufficient safety equipment or machinery to provide care effectively.
• Being forced to work overtime or miss meal breaks.

ADO paperwork helps provide legal protection for nurses who believe they may be put in an unsafe patient care situation. “Whistleblowing” the potential for patient harm doesn’t completely remove liability from the nurse, but it does raise concerns for facility leadership and can put them on notice of elevated patient care risks. State nursing boards and nursing unions encourage staff to complete ADO paperwork to protect themselves and their patients.

What Does ADO Paperwork Look Like?

Each state nursing board or nursing union utilizes its own version of an ADO form , which covers employees working in that state. While they all vary in terms of layout or design, each form contains similar elements, including:

• The nurse’s name, license number, and place of employment.
• The supervisor’s name and date/time of notification.
• The reason for the nurse’s objection.
• The unit’s census details, including the number of patients and staff members.
• A space to outline any actual or potential patient harm that may have been caused.

Assignment Despite Objection: Example Scenario

The ADO process can seem confusing out of clinical context. The table below lists the steps involved when a nursing professional files an ADO, along with a scenario to help highlight the process in a realistic clinical situation.

Managing an ADO: 5 Tips for Facilities

As you review how the Assignment Despite Objection form submission process works, you’re probably looking for tips on how to effectively manage these situations in your unit or facility. Below, we review five key strategies for managing an ADO safely and effectively.

1. Ensure All Patient Assignments Meet Mandated State Staffing Ratios

A key step to keeping clinical operations running smoothly is to prevent ADO situations from arising in the first place. Adhering to your state’s legally mandated staffing ratios is the first step to ensuring compliance and safety .

2. Provide Staff Training on ADO Protocol

Many nurses might not be familiar with the ADO process. They may not know how to speak up if they find themselves in a situation where they aren’t able to practice safely or competently. One way to prevent this from happening is to include Assignment Despite Objection education as part of your employee onboarding training .

Be sure to show staff where to find the forms, explain how to complete them, and relay who to submit them to when necessary. This not only helps your staff feel empowered and supported, but also ensures that your patients receive the best possible care.

3. Encourage Team Cohesion

As the term “objection” implies, ADO submissions can become contentious if management and nursing staff perceive each other to be on separate teams. It’s important that both sides abandon the “them versus us” mentality and understand that the entire unit is focused on preserving staff and patient safety.

Team bonding activities can help to unite facility leadership and bedside staff and ensure that no side feels like they’re fighting against the other. Collaborative team meetings can also help clinical leaders and staff work side-by-side to discuss mutual issues and problem solve together.

4. Incorporate Per Diem and Float Pool Nurses to Cover Schedule Gaps

One of the most common reasons an ADO arises is due to short staffing . By utilizing flexible staffing solutions, you can ensure that all patient assignments can be safely distributed, even during high census.

Per diem nurses, who work only one or two shifts a week, could be added into the staffing matrix on busy shifts or during predictable nursing shortages like maternity leaves or staff vacations. Float pool nurses, alternatively, could be requested on short notice to assist with unpredictable staff shortages like sick calls.

5. Review Submitted ADO Paperwork to Plan Long-Term Solutions

The submission of an ADO form only means that the situation has been documented. It doesn’t mean that the situation was handled safely or that outcomes were improved.

Therefore, it’s essential that facility management reviews those forms and performs a root-cause analysis to prevent future improper patient assignments. Typically, this is done in unit leadership meetings or in a facility-wide shared governance committee .

Discover More Ways to Promote Patient Safety in Your Facility

Safely managing an Assignment Despite Objection situation prevents future patient harm and ensures your staff members practice safely and effectively. Follow along in our expertly-written newsletter for additional tips and strategies on encouraging employee engagement and optimizing care quality.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.

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Staffing Complaint / Assignment Despite Objection Forms (ADO forms) Question and Answer

Posted Oct 13, 2020

Question. What is ADO form? Answer. A Staffing Complaint/ADO is a form that documents a good faith effort on the part of a nurse to call attention to problems that affect nurse and/or patient care, safety, or satisfaction. The goal is to fix these problems and ensure they don’t reoccur. Filling out and filing an ADO form may protect you one day if ever an untoward outcome should occur with yourself or a patient . Q. Why should I fill out ADO forms? A. Staffing Complaint/ADO forms provide documented evidence that a problem exists on a unit and initiates a process for improving the situation. Once management has been presented with an issue, it is incumbent upon them to address it. Additionally, you are documenting the facts , which may be helpful to you if there is a negative outcome. The submitted Staffing Concern/ADO also provides the Staffing Committee members with specific details, rather than with anecdotal examples about staffing complaints, and helps them determine if a complaint has been resolved or not. The Staffing Committee has the legal responsibility to determine if staffing complaints are resolved or unresolved. Complaints that show an unresolved trend for 60 days or more could result in an investigation by the Department of Health and possible fines. When appropriate, some complaints may be taken to Conference Committee by our WSNA Local Unit officers to try to resolve the concern. Registered nurses have the responsibility to report when care is unsafe. If unsafe situations go unchecked, those we serve may be put at risk, and you put your RN licensure at risk. Q. ADO when and how? A. If you feel your situation/assignment is unsafe, you need to report it to your charge nurse or manager as soon as possible and go up the chain of command if time permits. Please do not simply reject the assignment because this may be viewed as being insubordinate. If the situation is not immediately addressed/remedied by Management, you need to fill out and file an ADO form as soon as you can. Also, it may help to think of completing an ADO form as an S.O.S. – Short on Safety, Short on Supplies, Short on Staff. Be detailed in your description of the issue/concern and please complete the form and ask other nurses who were affected complete one as well Q. Where do I find this form? A. You can find WSNA ADO forms by going to http://www.wsna.org/ado . Q. Who can fill out this form? A. Any nurse that is covered under our contract. Q. Will my manager or I get in trouble if I fill out this form? A. This form is not meant to get anyone in trouble or penalized. This form is intended to help out the staff and surface concerns. It is actually illegal to retaliate against any nurse for submitting any complaint related to staffing. If any nurse feels they are being penalized or retaliated against by their manager for filling out an ADO, please let any of your officers or Travis Elmore know. Q. Can you provide examples of when it would be appropriate for me to submit an ADO? A.

• Your unit is not staffed according to its staffing plan.
• Shift adjustments to staffing are inadequate.
• Charge nurse is unable to perform charge nurse duties, secondary to increased patient care assignment
• Inadequate nurse to patient ratios for patient acuity based on your clinical judgment; insufficient support staff
• You are not trained or experienced in the area assigned, or have not been oriented to this unit / case load
• Necessary equipment is not available (supplies, IVs, medication availability), or you are not trained or experienced to use equipment in assigned area
• An assignment poses a threat to the health and safety of a patient under your direct care
• Coerced/Mandatory overtime, or missed breaks

Q. What happens with the form once it is completed? A. Please enter your manager’s E-Mail address so that they get a copy. Once submitted, you, your local unit chair, WSNA rep and staffing committee leaders are automatically copied. This form will be presented at the next hospital staffing committee meeting or nurse conference committee meeting. Q. What if I have a question? Who do I contact and is there a time line? A. Email one of your officers or Travis Elmore WSNA Rep. If you can give us the form within 48 hours of the actual incident, that would be helpful. Again, our WSNA/PeaceHealth St. John contract and the law both prohibit retaliation against nurses for filing a Staffing Complaint/ADO

Do you want to make a difference for your coworkers at PeaceHealth St. John Medical Center? Help shape your workplace culture by becoming a Grievance Officer! Grievance officers go with RN’s to meetings with management and support RN’s should they choose to file a grievance. The time commitment is approximately 4-6 hours a month but the impact on the lives of your fellow RN’s is enormous! To learn more about how to become appointed as a grievance officer, contact your WSNA Nurse Representative!

Questions? Contact WSNA Nurse Representative Travis Elmore at [email protected] or 206 -575-7979, ext. 3117.

Michigan Nurses Association

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Assignment Despite Objection Forms

Online ado forms.

Traditional ADO form

MNA-UMPNC ADO Form

Ambulatory Care ADO form

Marquette Ancillary Staff and Technologists ADO form

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Document Unsafe Staffing: Assignment Despite Objection Form

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SEIU Healthcare – United for Quality Care

Print out assignment despite objection (ado) forms.

See the Instructions and Links for Downloading ADO forms below:

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Objection to Assignment forms: A key tool for keeping patients and nurses safe

Nursing April 25, 2024

What is an OTA?

An Objection to Assignment (OTA) is a tool to record your objection to an assignment, which is unsafe for you, your coworkers, and/or your patients. On the OTA you document the specific reasons why your assignment poses a risk to staff and/or patients and that you have notified management of these problems.

Why should I fill out an OTA?

There are many reasons to fill out an OTA:

• To document that you have notified your employer that your assignment poses a risk to staff and/or patients.
• In the event that patient care is compromised as a result of unsafe working conditions, an OTA form documents your objection to these conditions and your employer’s failure to address them.This puts responsibility for lapses in patient care squarely on the employer.
• OTAs document issues that can be taken to regulatory agencies like Cal/OSHA or the California Department of Public Health. Filing regulatory complaints helps us advocate for our patients and safe working conditions.
• To build power in our workplace: when multiple nurses object to assignments, we are collectively showing management that unsafe working conditions will not be ignored and must be addressed. OTAs are one way we can hold our employer accountable for understaffing and decisions that put patients and staff at risk.

When should I fill out an OTA?

All NUHW members (not just stewards) should fill out an OTA anytime your assignment is unsafe for patients or staff and management fails to immediately correct the issue. Here are the steps you need to take:

• When you get your assignment, you must first notify your supervisor that it is unsafe. (You can verbally tell your supervisor or, if they aren’t readily accessible in-person, you can text, call, or email them.)
• If your supervisor does not immediately address your concerns and correct the issues, you must then inform them that you are accepting the assignment only because you are being instructed to do so, despite your objections.
• After communicating your objection to your supervisor either verbally or in writing, fill out an OTA to document the date, time and location as well as the reasons for your objection. Do NOT include any protected health information (patient information/identifiers) in your OTA.
• OTAs can be completed either online at https://nuhw.org/ota or in hardcopy form. On the online form be sure to include your supervisor’s email so a copy is sent to them. If you complete a hardcopy OTA, please provide a copy to your supervisor and your NUHW representative.

What are some examples of things to document on an OTA?

• Understaffing including violations to California’s nurse-to-patient ratio regulations in hospitals. Be sure to provide examples of how the understaffing compromises patient care and safety like late medication passes, worsening pressure ulcers due to inadequate repositioning, preventable falls or other injuries etc.
• Broken or missing equipment or other workplace hazards.
• Not enough or incorrect PPE.
• Failure to appropriately isolate and/or cohort patients with infectious diseases.
• Unsafe patient handling (not enough staff to safely reposition, lift, transfer, ambulate a patient etc.).
• Inadequate training or orientation for an assignment.
• Any other issue which puts you, your coworkers, or your patients at risk.

Can I be disciplined for filling out an OTA?

You have a legal right to voice an objection to an assignment that is unsafe for staff or patients and to document that you are only accepting the assignment because you have been instructed to do so, despite your objection. Most supervisors are aware of this right and are familiar with the OTA process. However, if a supervisor tries to stop you from filling out an OTA or retaliates against you, please notify your steward(s) and NUHW representative immediately.