What is an ADO and how does it apply to me?

If you find yourself in a situation that you believe creates unsafe conditions for patients or for you, complete the Staffing Complaint / ADO (Assignment Despite Objection) form as soon as possible.

Complete the online form and your WSNA Nurse Rep, Staffing Committee, and Local Unit Chair / Co-Chair will be notified immediately.

To launch the form click HERE 

By completing the form, you are helping to make the problem known to management, which creates an opportunity for the problem to be addressed. Additionally, you are documenting the facts, which may be helpful to you later if there is a negative outcome.

Types of situations where you should complete a Staffing Complaint / ADO form:

• 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 requires you to assume additional duties
• You are not trained or experienced in the area assigned
• You have not been oriented to this unit / case load
• Patient care equipment missing or unusable
• Necessary equipment is not available (e.g.: supplies, IVs, medication availability)
• You are not trained or experienced to use equipment in assigned area
• System failure (e.g.: computer, phone, pyxis, call system)
• An assignment poses a serious threat to your health and safety
• An assignment poses a serious threat to the health and safety of a patient under your direct care
• Forced / mandatory overtime
• Missed breaks

St. Luke’s is required to adhere to the agreed upon staffing plan by the Hospital Staffing Committee. ALL nurses should be aware of the staffing plan, and know how to access it.

Want to see the staffing plan for St. Luke’s? Look no further, it’s public! Click HERE 

Your Task? The ASK

Nurses must fill out ADOs documenting the unsafe situations/violations to the law. By doing so, you are protecting your practice and holding St. Luke’s accountable to what is in the law.

In order for us to enforce the law, we need as many ADOs as possible from nurses documenting what is occurring on the floors.

The hospital may not retaliate against or engage in any form of intimidation of an employee performing any duties or responsibilities in connection with the nurse staffing committee.

When filing out an ADO, it’s important to state what happened AND include the following language in your ADO (We recommend you copy and paste this wording directly into your ADO):

“I was not relieved to take a meal/rest break this shift (add date and shift). Taking a meal/rest break would have resulted in leaving the unit/department with fewer direct care nursing staff to deliver patient care than is required by the nurse staffing plan”

OR

“I was not able to take a meal or rest break without leaving the unit/department with fewer direct care nursing staff to deliver patient care than what is required by the staffing plan”

As stated above, the only way we can enforce the law is to receive ADOs from you. Some of you have taken the time to do this, nice work! Keep them coming. We are in this together.

Meal and Rest Breaks: Know your rights under the law

Did you know? For every 12-hour shift, nurses get the following:

• 2 unpaid 30 min meal periods (you can waive one of them via signed waiver)
• 3 paid 15-minute rest breaks. Legally, you can combine up to two 15-minute rest breaks with one unpaid 30-minute meal period if agreed to by the employer.
  • If nurses combine one 15-minute rest break with one unpaid 30-minute meal period to equal 45 minutes of time to rest, you are still entitled to two more rest breaks before the end of your shift.
• If you do not get all your rest breaks, then they are considered to be missed, and this should be documented in the timekeeping system and appropriate compensation provided to the nurse.

Want dive deeper? We are here for you!

Under WAC 296-126-092, employees are entitled to the following rights:

1. Employees shall be allowed an unpaid meal period of at least thirty minutes for every 5 hours of work, which commences no less than two hours or more than five hours from the beginning of the shift.
   1. No employee shall be required to work more than five consecutive hours without a meal period.
   2. Employees shall be allowed a paid rest period of at least 15 minutes, on the employer's time per article 4.11 of the WSNA contract and for each four hours of working time. Rest breaks shall be scheduled as near as possible to the midpoint of the work period.

Why is this important?

If you have not signed a waiver with the employer waiving the timing of your meal or rest breaks, then any of those breaks outside of the lawfully prescribed timeframe is considered to be missed.   If your meal is missed, you are entitled to an additional 30 minutes of pay at the back end. For every rest period that is missed, you are entitled to an additional 15 minutes of pay at the back end.

Employees, once a waiver is in place, are legally able to withdraw the waiver at any point during their shift.

Meal and Rest breaks can only be interrupted for VERY specific reasons:

• RCW 49.28.130 "Unforeseeable emergent circumstance" means
  • (a) any unforeseen declared national, state, or municipal emergency;
  • (b) when a health care facility disaster plan is activated; or
  • (c) any unforeseen disaster or other catastrophic event which substantially affects or increases the need for health care services.

The goal of this legislation is for staff to be able to fully step away from their assignment by leaving their phone/Vocera with another staff member. The ideal is to have a meal and rest break RN who can provide these breaks. Do other hospitals do this? Yep, they sure do.

Staffing Matrix

Hospitals (including St. Luke’s) are required to post their approved staffing matrix (staffing plan) in a visible public location on every unit. Each staffing matrix lists the total number of staff per patient. Here are some key elements that everyone needs to be aware of:

1. The number of staff on the matrix is the minimum number required under the law to safely staff the unit.
   1. The law specifically calls out the use of acuity when establishing how many staff are needed to be safely staffed.
   2. The number of staff listed is the number of staff that must legally be on the floor providing direct patient care at all times for the facility to be in compliance.
   3. When a staff member leaves the floor to take a meal or rest break, there is no other staff member with the same clinical qualifications to replace them; the unit is now out of compliance.
   4. Staff are asked to file an ADO in these situations, and please make sure you are filling out the actual and planned staffing numbers on the form.

All work and no play? No WAY!

Nurses week is coming! Your Local Unit Officers and Liaisons are hard at work, planning your 2026 nurses week. If you would like to be involved in these fun and exciting efforts, email jsmedley@wsna.org to find out more!

Not a member? No problem!

Click here to join your colleagues and be a WSNA member! Your unit is only as strong as your membership numbers. Membership helps us prepare for bargaining next year. Click here to get started.

Questions? Comments? Contact one of your WSNA officers or your nurse rep, Jaclyn Smedley BSN, RN at jsmedley@wsna.org