Unsafe Staffing Forms

Unsafe staffing forms—a tool to improve patient care and protect your practice

Online Forms | Hospital Setting | Community Setting

Print Forms (PDF) | Hospital Setting | Community Setting

Maintaining and enforcing staffing guidelines continues to be one of the most challenging and frustrating issues we face as RNs. Our safe staffing legislation to mandate safe patient ratios is refilled and before the legislature but until it becomes law  but we will need to continue to utilize all our contractual and professional resources as we maintain our efforts to guarantee safe registered nurse staffing levels at all times.

No unsafe staffing assignment should go undocumented. A critical element in documenting unsafe situations is the completion and submission of unsafe staffing/technology forms. Below we have tried to provide answers to some of the most commonly asked questions and concerns posed by nurses related to our unsafe staffing/technology forms.

  • Why should I fill out unsafe staffing forms?
    It is the best means of documenting unsafe working conditions. It may be the single piece of evidence that could save your license to practice, if something were to happen to one of your patients on the shift you worked where staffing was unsafe.
  • How will documenting on these forms protect my license?
    The Board of Registration of Nursing (BORN) and the court system hold individual nurses accountable for the safety of their patients. In the event a patient is harmed due to the care on your shift and you are sued or brought before the Nursing Board, an unsafe staffing form provides documented evidence that you were working under duress, that you took responsibility to notify your supervisor of your objection to these conditions, and what actions if any were taken to support you. This evidence might prove extremely valuable in the defense of your license. When you consider the benefits, unsafe staffing reports are not a senseless chore; they are your most powerful tool and your best defense.
  • What is an unsafe assignment? At your hospital, there are staffing plans that reflect the patient/nurse ratio. Does that mean our assignments are always safe?
    As registered nurses we are obligated to protect the safety of our patients and are legally responsible in the eyes of the BORN. An unsafe assignment is anything that you, the assigned RN, judge to be unsafe. It is your license. When in doubt, talk to your most senior experienced colleagues and solicit their help in evaluating your situation.
    In response to the second question related to the number of patients per nurse, patient acuity and patient ratios must be taken into account in nurse/ patient assignments. For example, if the budgeted plan state the ratio is four patients per nurse, but one of your surgical patients requires constant monitoring, it may not be safe for you to be assigned four patients. The assignment should be adjusted to reflect the time required to meet the needs of the assigned patients. In any unsafe assignment situation, you should contact your supervisor/manager and insist that she/he adjust your assignment.
  • Will the unsafe staffing/technology forms reflect poorly on my manager?
    No. Filling out unsafe staffing forms is an objection to an unsafe situation that puts both the patients and the nurse at risk. As a registered nurse you have the responsibility to give the best possible care to your patients and can legally be held accountable for your actions in providing that care. Your manager is responsible and accountable for providing safe staffing on all shifts.  Submitting unsafe staffing forms is an important legal protection in a given situation is your best legal protection, especially in situations where you believe that the circumstances are beyond the control of your manager.
  • I am afraid that my manager will be angry if I file a staffing objection and make my life at work difficult.
    Such actions by a manager are inappropriate as well as violations of both your contract and the National Labor Relations Act. Your actions are “protected activities,” that is they are protected under labor law. Be assured that your union is firmly behind you in aggressively protecting your rights. If you feel that your manager is trying to intimidate or dissuade you in any way please contact an MNA committee leader; you do not have to shoulder this responsibility alone.
  • I never have time to fill out the forms; do I have to fill it out that shift?
    It is advisable to fill out the form as soon as possible.
  • What happens to the completed unsafe staffing/technology forms?
    These forms are used by your MNA bargaining unit to identify and resolve staffing/technology issues or problems.  These forms may be used differently in each bargaining unit.  A copy of the form should be given to the MNA Associate Director responsible for your unit.
  • What do I do with the forms after I fill them out?
    Always keep a copy for yourself. Give your manager/supervisor a copy and a copy should go to MNA at fax 781.821.4445. Together we can make sure our patients and our licenses are always safe.
  • Download an informational flier.

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Report Safe Staffing Forms

Online Forms | Hospital Setting | Community Setting

Print Forms (PDF) | Hospital Setting | Community Setting