This online staffing complaint/ ADO form was developed by a coalition that included WSNA, SEIU, UFCW and WSHA representatives. Completing the form serves many purposes, including data tracking, bring issues to light, supportive documentation and discussion tool to make things better. It is not punitive.

This form is to be completed for issues including but not limited to:

• The unit is not staffed according to its staffing plan or if mid-shift staffing adjust­ments are inadequate. (In order to know if your unit is not staffed according to its staffing plan, you must first know what the staffing plan for you unit is. Staffing plans, including nursing and unlicensed staff, are required to be posted on every unit.)
• Missed breaks or earned time denied
• In the event of equipment issues or system failure

If you have reason to complete this form, you first should speak with your manager or charge nurse for that shift in order to try to resolve the concern as quickly as possible. When you complete the online form, you are encouraged to include your manager’s name and email.

After you complete the form a copy of the submitted form immediately goes to you, the WSNA chair and co-chair, WSNA Rep, staffing committee co-chairs, and your manager, provided you have entered his or her email. The Nurse Staffing Committee will review the complaint at their next meeting if it is a staffing concern. The Nurse Conference Committee will review the complaint at their next meeting if it is of other concern.

Find the staffing complaint form at wsna.org/ado.

Questions? Contact WSNA Nurse Representative Sara Strite at sstrite@wsna.org.