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Click ‘Get Form’ to open the protest of assignment document in the editor.
Begin by filling in your facility code and the date at the top of the form. Ensure you use block letters for clarity.
Enter your name and the nursing unit you represent. This identifies who is submitting the report.
Indicate the time management was notified using a 12-hour clock format, specifying AM or PM.
Select the type of nursing unit that best applies by shading the appropriate option from CCU/ICU to Ambulatory Care/Clinic.
Document your staffing situation by writing numbers in the boxes provided for regular staff, float, and agency personnel.
Shade all applicable reasons for protesting this assignment, such as inadequate staffing or patient acuity concerns.
Provide any additional comments that may support your protest in block letters.
Sign and date the form to confirm your professional judgment regarding safety concerns related to patient care.

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What is an act of protest?

A protest (also called a demonstration, remonstration, or remonstrance) is a public act of objection, disapproval or dissent against political advantage.

What happens if a nurse refuses an assignment?

Refusing an assignment may lead to consequences, both formal and informal, including potential disciplinary actions or animosity from colleagues. Nurses should document their refusal and communicate concerns to supervisors to protect their licenses and ensure patient safety.

What is protest of assignment?

A protest of assignment (POA) is a written document notifying the employer that a nursing assignment is unsafe. As nurses, we would never turn down an assignment. But as patient advocates, it is our duty to do everything in our power to correct unsafe situations.

What is an example of assignment in nursing?

An example of a client assignment is when an RN assigns an LPN/VN to care for a client with stable heart failure. The LPN/VN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN/VN documents this information and reports information back to the RN.

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