File an ADO


A registered nurse receiving an assignment that in her/his professional judgment places patient(s) or themselves at risk has an obligation to take action. Acting in the interest of patients, the nurse should promptly notify her/his supervisor that because of inadequate staffing, the quality of care and the safety of patients and nurses may be jeopardized.
The Ohio Nurse Practice Act and the ANA Code for Nurses hold the nurse responsible and accountable to her/his patients for the nursing care provided. However, responsibility and accountability for the level of care also resides with the Hospital, including both Hospital and nursing administrative staff.

The accompanying “Assignment Despite Objection” form may be used to document an assignment which is potentially unsafe for the patients or staff. This form should also be used to document concerns about potentially unsafe conditions that may arise when a nurse may be required to delegate inappropriately to unlicensed nursing assistants.


  1. Do notify your supervisor (your unit director, if here; Administrative Supervisor if absent) for help as soon as you realize the problem; the staffing numbers provided are less than what you need to provide proper and safe nursing care.
  2. Do state that you will do the best you can if help is denied, but that patients have the right to receive safe professional nursing care.
  3. Do fill out the attached form and give it to the nursing supervisor on duty prior to the end of your shift. The Assignment by Objection form is then completed by the nursing supervisor.
  4. Do forward a copy to ONA and retain a copy. Add documentation on the back of the form, if needed.
  5. Do remember that nursing management may discipline a nurse for refusing an assignment. A nurse who has been disciplined for protesting an assignment should file a grievance against the employer for discipline without just cause.
  6. Do provide a copy of the form to the ONA steward.


  1. Don’t use the form if you have adequate help. If these forms are used indiscriminately and without justification, it will dilute their usefulness.
  2. Don’t use the form if you have failed to notify your supervisor in person or by phone of your need for more help. This form is to document your request. If you didn’t make the request, you can’t use it


Members are responsible for printing and turning the completed form below in to their manager and area rep/board member.