Skagit RNs! You are doing  a phenomenal job at filling out and submitting ADOs for issues surrounding your meal or lunch breaks. Your ADOs are making a difference!

Keep them coming!

Why do we need ADOs you ask? Look no further, we have outlined the specific reasons for you below.

Per RCW 70.41.420, when referring to ADOs it says, “A nursing staff may report to the hospital staffing committee any variations where the nursing staff assignment in a patient care unit is not in accordance with the adopted staffing plan and may make a complaint to the committee based on the variations.”

By nurses filling out ADOs, you are submitting a complaint to the Hospital Staffing Committee per the language above indicating the Staffing Plan is not being followed and requesting the committee address the issue.

Per RCW 70.41.420, the use of break buddies is not considered to be in alignment with the Hospitals Staffing Plan. RCW 70.41.420 #7 (b) states “Each hospital shall document when a patient care unit nursing staff assignment is out of compliance with the adopted hospital staffing plan. For purposes of this subsection, out of compliance means the number of patients assigned to the nursing staff exceeds the patient care unit assignment as directed by the nurse staffing plan.” 

Therefore, for management to direct nurses to double their patient load, so another nurse can take a break, they are exceeding the patient care unit assignment as directed by the staffing plan and this is a violation of the law.

The reporting mechanisms by hospitals which is required as of Jan 1, 2026 (which will address the previous 6 months), will need to capture compliance as well as non-compliance. The monthly noncompliance report form required by hospitals to submit to the DOH states “Compliance is to be maintained throughout each shift”. The semiannual compliance form required by hospitals to submit to the DOH also states “Compliance is to be maintained throughout each shift.”  Each form includes the following sentence “Each hospital needs to ensure that its policies and procedures, when implemented, result in accurate information being reported.”

What does this mean? It means the hospital is out of compliance with the staffing plan if the numbers in the staffing plan are not maintained throughout the shift. Thus, if you are being asked by management to give your patient load to another RN, who also has a patient load while you are on break, that is a violation of the staffing plan.

Question? Can management assess compliance at two points within any given shift?

Answer – Compliance must be maintained throughout the shift. Therefore, if management is assessing compliance at only two specific points, that is not ensuring compliance is happening during the other times within the shift.

DOH’s Frequently Asked Questions on their website responds to the question as well.

• “Will hospitals receive a compliance citation for using “break buddies”?
  • DOH’s FAQ states “Hospital staffing plan compliance will be determined by what is in the hospital’s staffing plan. Compliance will be assessed by looking at the number of nursing staff and patient assignments throughout a shift and evaluating if that matches what is in the hospital’s staffing plan.” To read the full FAQ use this link

So, I fill out an ADO, then what happens?

Per the law, any nurse has the ability to make a complaint to the Hospital Staffing Committee. The ADO forms are just that. All ADOs submitted by RNs go to WSNA and the Hospital Staffing Committee. (ADOs are different from Staffing Concern Forms, as those stay internal only and do not go to WSNA) Be sure to use ADOs only!

All ADOs are to be reviewed, investigated and voted on by the committee which is made up of 50% WSNA nurses and 50% management. The forms are voted and classified as one of the following:

1. Resolved - HSC agrees complaint has been resolved.
2. Staffing Plan - Hospital followed nursing personnel assignments in a patient care unit as called for in the staffing plan.
3. Outside of HSC Scope - Evidence does not support the staffing complaint/complaint was not RN staffing related and concern was sent to the appropriate committee.
4. Reasonable Efforts – SRH Documents it has made reasonable efforts to obtain staffing but has been unable to.

“Reasonable efforts" means that the employer, to the extent reasonably possibly, does all of the following but is unable to obtain staffing coverage:

1. seeks individuals to volunteer to work extra time from all available qualified staff who are working;
   1. contracts qualified employees who have made themselves available to work extra time;
   2. seeks the use of per diem staff; and
   3. seeks personnel from a contracted temporary agency when such staffing is permitted by law or an applicable collective bargaining agreement, and when the employer regularly uses a contracted temporary agency.
2. Unforeseeable Emergency
3. Unresolved – HSC agrees the complaint was not resolved
4. Unresolved – HSC is unable to agree if the complaint has been resolved

Complaints must be resolved within 90 days of receipt (this deadline can only be extended by approval of the committee). If they are not resolved, and the hospital fails to exhaust all reasonable efforts, a complaint can be made to the department (DOH) requesting formal investigation. (Link to RCW entry regarding investigations)

To view the SVH Staffing Committee Charter, review complaint process beginning on page 8, and to learn more about how this committee operates per the law, use this link.

THIS IS NOT OKAY. 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 the hospital 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. KEEP THEM COMING.

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. Keep them coming Skagit RNs. We are in this together.

For any questions, concerns or comments reach out to Nurse Representative Jaclyn Smedley BSN, RN at jsmedley@wsna.org