The critical role played by Protests of Assignment

The Protests of Assignment are a serious matter. Attested to by NYSNA members, these documents serve as evidence of unacceptable conditions on the Units. Last year, there were a total of 22,657 POAs with 80,631 nurse signatures affixed, i.e., an average of close to four signatures per POA.

That speaks volumes to both our unity and the magnitude of problems on the Units.

More than 80 percent of POAs relate to understaffing. Most come from Med/Surg Units, followed by Stepdown/Telemetry, then the Emergency Departments, Maternity (L&D), and CCU/ICU/MICU.

A copy of each POA is sent to management and is submitted to NYSNA staff, which enters it into the union database. An analysis is compiled by “specialty unit”, “shift”, and “reason(s)”. A report is prepared in terms of unit, shift and reason.

At this juncture, a hospital report card is prepared, or what we call the “Patient Care Chronicle.”

(See p. 10 for a sample page from a current Patient Care Chronicle.)

The Patient Care Chronicles have many purposes. They are used at:

  • Negotiations
  • Lobbying
  • Meetings with legislators
  • Arbitrations
  • They are also integral to the filing of complaints at
  • Department of Health
  • Joint Commission
  • Department of Labor

    The data is statistically valid and reliable to show corporate negligence and to demonstrate what’s required under the laws that registered nurses serve.

    A page out of a patient care chronicle

    Figure 3: Most Frequent Reason for Protest of Assignment

    The 1,445 hospital-wide POAs filed at Maimonides Medical Center between January 1, 2018 and December 31, 2018 documents the following perceived inadequacies and unsafe conditions:

  • Nurses are protesting their assignments because of the inability to adequately address the patient acuity, given the staffing assignment. Higher patient acuity comprises over 73% of the protests filed throughout the hospital.
  • Nurses are protesting their assignments because of the inadequate numbers of qualified staff needed to address the acuity, admission volume, discharges, and caseloads. Inadequate numbers of qualified staff comprises over 85% of the protests filed throughout the hospital.
  • Nurses are protesting their assignments because the numbers of patients assigned to the nurse impedes safe delivery of care. The unsafe nurse-to-patient ratio comprises over 85% of the protests filed throughout the hospital.
  • Nurses are protesting their assignments because the volume of admissions and discharges (51% of the protests) and patient caseload (81% of the protests) leave them with inadequate time for documentation. Inadequate time for documentation comprises over 83% of the protests filed throughout the hospital.
  • In addition to the reasons noted above, nurses have identified “other” reasons for the filing of the POA in 29% of the protests filed throughout the hospital (See Table 1).

    “At Staten Island University Hospital alone, 1,815 POAs have been filed over the last three years that include complaints from over 8,600 nurses...” "In 2017, at hospitals where our nurses provide care, tens of thousands of nurses signed POAs and the vast majority of them pertained to understaffing. From 2015 to 2017, in hospitals serviced by NYSNA nurses, over 69,000 POAs were submitted with signatures from over 280,000 nurses. More than 80 percent of those were because of safe staffing issues."

    “Already short staffed and admissions keep coming (ER quickly filling up) with no imminent increase in staffing. Patients arriving every 5-10 minutes,” “Unsafe staffing in both nurseries. No NAs in both nurseries and acuity is high. Same situation on both fifth floor and sixth floor” and “Not enough RNs to admit and discharge patients …RNs not able to check on patients every 1-2 hours.”

    “...the union presented documented reports of 3,800 “Protests of Assignment” signed by over 20,000 nurses...”

    "Insufficient space, hallway patients, patients stacked in rows, unable to access patients in a timely manner, temp in ED 76 degrees on west side, air conditioning not working on East side and area is very hot and uncomfortable, inadequate ventilation, unable to comply with appropriate infection control. Patients waiting days to get a bed and aggressive to staff."

    “...more than 2,500 complaints, known as protests of assignment, from nurses at the three health systems.”

    “In 2018, 20,000 nurses ... signed protests of assignment for unsafe conditions, including a six-hour wait time for pediatric patients in the emergency department, unsafe staffing in the neonatal intensive care unit and patients stacked on stretchers in hallways for days waiting for an available room.”

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