Making your staffing complaint count
Every effectively documented complaint helps identify gaps in the current law and strengthens our advocacy for change through the legislative and collective bargaining processes.
Filing staffing complaints is an essential element of enforcing Washington’s 2023 hospital staffing law. While Assignment Despite Objection (ADO) forms are commonly used, they are not the only way nurses can document a staffing concern. What matters most is submitting a written staffing concern that includes objective, detailed, and actionable information. An effective staffing complaint clearly reports a violation of the law and gives your staffing committee the critical information it needs to take action.
Thorough, objective documentation creates a record of staffing conditions, including compliance with minimum staffing standards, patient-care impacts, and safety concerns. It helps identify recurring issues and provides key stakeholders with valuable information about staffing conditions.
Washington’s 2023 staffing law requires hospitals to have staffing plans that establish minimum staffing standards for each unit and shift. Hospital staffing committees, made up of direct-care nursing staff and management, create, review, and approve these plans.
A nurse can file a staffing complaint when:
- The unit staffing assignment does not comply with the hospital staffing plan throughout the shift.
- A shift-to-shift staffing adjustment is made and nursing staff object to the adjustment, including the use of break buddies.
Remember: The staffing plan establishes minimum staffing for the unit overall, not individual nurse-to-patient ratios. If the unit meets the minimum staffing requirements, a complaint based solely on an individual nurse’s assignment or ratio does not identify a violation of the staffing law and generally will not be actionable by the hospital staffing committee or by regulatory agencies such as the Washington State Department of Health (DOH) or Department of Labor & Industries (L&I).
- Be specific. Know what your staffing plan requires and explain exactly how the staffing assignment or adjustment differed. Document the patient census for the shift, the number of nurses assigned to work by job class, and the number of nurses required by the staffing plan.
- Stick to the facts. Avoid emotional or accusatory language. “We were very busy” is less useful than describing the specific staffing condition.
- Document your actions. Follow the appropriate chain of command and document the steps taken to address the concern.
- Include the basics. Provide the date, time, unit, shift, staffing condition, applicable staffing-plan requirement, and actions taken. Adding the patient census, required staffing, and actual staffing is important
Avoid including specific patient information
- Because ADO content is not confidential, including patient information can create a HIPAA concern that may result in discipline.
- Do not document in the patient’s medical record that an ADO was filed.
Avoid nurse-to-patient ratio statements or demands
The staffing plan establishes minimum staffing for the unit, not individual nurse-to-patient ratios. Complaints based solely on an individual nurse’s assignment or nurse-to-patient ratios will not be actionable if the unit meets the minimum staffing requirements established in the approved staffing plan.
Following these guidelines helps staffing committees act on documented concerns and provides a clearer picture of staffing conditions across facilities.
WSNA is committed to safe staffing. Every effectively documented complaint helps identify gaps in the current law and strengthens our advocacy for change through the legislative and collective bargaining processes.
| Employee Name | John Doe | Facility | St. Elsewhere |
| Jdoe243@gmail.com | Manager Email | Kjones@elsewhere.org | |
| Manager Name | Karen Jones | Unit/Dept. Type | Medical-surgical |
| Unit/Dept. Name | 7 West | Time of Incident | Day shift |
| Date of Incident | 6/30/2026 |
Core Staffing: Fewer nurses were assigned to deliver direct patient care on 7 west, day shift on 6/30/2026 than required by the hospital staffing plan. The unit staffing had 1 less RN and 1 less CNA than required by the HSP for the entire 12 hour day shift.
Patient | Required | Actual | Required | Actual | Required LPNs | Actual | Required | Actual |
30 | 6 | 5 | 3 | 2 | 0 | 0 | 1 | 1 |
Break relief: In addition, there were no nurses to provide break relief during the shift. Both RN and CNA core staff were required to use break buddies to provide break relief. This resulted in even fewer nurses delivering direct patient care during all meal and rest breaks on day shift than required by the hospital staffing plan.
| Issue | Common complaint descriptions | Better descriptions that align with the staffing law |
| Fewer nursing staff assigned than required by the hospital staffing plan (HSP). | “I had to care for too many patients.”“Staffing was unsafe.”“I had to care for 1:6 patients.” | “The number of nurses assigned to our unit was less than is required in the hospital staffing plan. Patient census, required nurse staffing, and actual nursing staff assigned is provided.” |
| Use of break buddies to cover meal/rest breaks. | “I didn’t get my breaks.”“No breaks, my patients were too sick.”“I couldn’t leave my patients assignment with another nurse-doubling hers.” | “Break relief nurses were unavailable, so I was unable to safely take scheduled meal and rest breaks.” “On day shift, my unit used break buddies to cover meal and rest breaks. This doubles the number of patients another RN takes while I am on break and there are fewer nurses delivering direct patient care during meal and rest breaks than is required by the hospital staffing plan.” |