CRONA
Committee for Recognition of Nursing Achievement
Area Representatives and Membership Meetings
August 5 and 7, 2008

Advocating for Patients, Peers, and Yourself

This article is intended to help you understand how staffing decisions affect patients, your peers, and yourself. Your main tools for understanding are:
•Staffing
•Grasp/Frontline/Evalysis
•Resource Nurse Role
•Assignment Despite Objection Form

STAFFING
Staffing is decided by assessing several factors including patient acuity, staff competence, skill mix, patient census, and staffing ratios. Staffing ratio minimums are mandated by California state law, AB 394.

Be familiar with the staffing ratios appropriate for your unit. Log on to crona.org and in the Search box, type “staffing ratios” for additional information.

GRASP/ FRONTLINE or EVALYSIS
Grasp/Frontline (LPCH) and Evalysis (SHC) are computerized patient classification tools used by nurses to record their patients’ acuity levels. The decisions on staffing levels depend on nurses recording their patients’ acuity levels accurately and timely.

As nurses, our assessment of patient acuity levels is a critical input in determining the staffing needs for the shift.

As nurses, we can advocate for our patients’ health outcomes by diligently completing the patient classification tool every shift.

RESOURCE NURSE ROLE
The RSN considers the competencies and skill mix of the available staff when deciding staffing needs and making patient assignments. In making these decisions, the RSN relies on the available information you provide through GRASP/ FRONTLINE or Evalysis.

Staffing ratios along with the tools GRASP/FRONTLINE or Evalysis are the primary tools helping the RSN in exercising judgment for making staffing decisions. It’s important to realize that these tools aide in exercising judgment.

The CRONA contract states that the RSN “is permitted to use judgment in adjusting staffing levels that may not be fully addressed by the acuity and staffing matrix.” Not all situations are covered by written laws and policies. So, RSNs have an important role in exercising good judgment, keeping patient health care as a primary goal.

The RSN can be an advocate for patients’ health and nurses’ rights by:
•Making sure the GRASP/FRONTLINE or Evalysis are completed every shift.
•Notifying your manager or supervisor when adequate staff is not available.
•Filling out and encouraging CRONA nurses to complete ADOs when appropriate.
•Notifying the manager when an ADO has been filled out so that s/he is aware of the problem and can follow up.

ASSIGNMENT DESPITE OBJECTION (ADO)
An ADO is a protest to an assignment that is not safe for patient care. ADOs are an important safeguard in the system that alerts CRONA and hospital management to potential problems so corrective action can be taken. There may be a number of reasons why an assignment is not safe. Examples include inadequate staffing and inadequate training. For more examples and information the Assignment Despite Objection form can be downloaded from crona.org.

It is important that your RSN is aware of the situation before you write the ADO since the goal is to fix the problem. In some cases, immediate action might need to be taken by the RSN. The RSN should, in turn, notify the manager on site or the nursing supervisor.

Fax the ADO to CRONA and give a copy to your manager so follow up can be initiated. Faxing is fast and provides a record of transmittal of the ADO. CRONA follows up on all ADOs and faxes them to the appropriate Patient Care Director.

Both CRONA and the hospital take ADOs seriously and take action by:
•The manager is required to respond to all ADO’s in writing within 14 days from the date the ADO is faxed to the Patient Care Director.

•ADOs are discussed by the Nurse Practice Committee, a joint CRONA and nursing management committee.

SUMMARY
Staffing for your unit can be challenging and frustrating. Some managers may ask you to staff according to the staffing matrix irrespective of patient acuity levels.

It is your professional responsibility to exercise your judgment when staffing your unit. It is a sign of strength when you are able to call your manager and assert why you need appropriate levels of staffing to handle specific acuity levels on the floor.

When staffing your unit or accepting a patient assignment, think about the type of nursing care your mother or child should receive if they were a patient on your unit.

Submitted by: Sunny Balson, Secretary

Please note:
Effective August 15, 2008, C1 at SHC will close permanently as a Rehab unit. We would like to thank the nurses on C1 for their dedication in caring for their patients for many years: Clarissa Bautista, Melanie Chang, Randy Cobar, Brenda Graham, Inga Hui, Beth Kaiser, Chris Lee, Shannon Lee, Maria Mallorca, Jannette Mendoza, Sharon Morte, Carmela Niverba, Paru Patel, Elvira Rambac, Ferdie Reyes, Fritzie Romey, Mae Silva, Amanda Sin, Phuong Smith, Nanette Soliman, Edna Soriano, Michael Torno,

Please welcome the C1 nurses as they transition to other units. Your patience and assistance in orienting them to another area of practice will help alleviate the stress and anxiety as they go through this change.

CRONA Convention October 7, 2008

On Tuesday, October 7, 2008, an attorney who specializes in workers compensation will speak at the annual CRONA convention. This one-hour presentation will be held at 8:30 am in the LPCH auditorium. Mr. McKenna will share information that will help us navigate through the maze and frustrations of work-related injury.

CRONA members are invited to attend this free session. Due to the annual convention that will be attended by area representatives, committee members and officers, attendance will be limited. Please email crona@crona.org by October 1, 2008 if you would like to attend. Continental breakfast will be served at 7:30 am.