Nurse Staffing Complaint Form (CSI)

This document was created in May of 2018 as a collaborative effort between WSHA, SEIU Healthcare 1199NW, UFCW 3000 (formerly UFCW 21), and WSNA. These organizations came together in early 2018 to develop sample tools that are intended to help hospitals implement House Bill (HB) 1714, which was passed in the previous legislative session. HB 1714 was intended to update and create some accountability to the nurse staffing committee process. The partners listed above recommend all hospitals use a Nurse Staffing Complaint Form to track staffing-related complaints and data coming to the nurse staffing committee. To create the following draft form, the partners reviewed HB 1714 as well as complaint forms used by a wide variety of hospitals in Washington. The following complaint form is based on an existing form used in Washington. While some forms reviewed contained additional elements, this form contains the minimum standard elements and best practices that the Coalition recommends be included in all forms. You can find the final bill, which shows the changes/additions from previous law, here. A nurse questioning an assignment is encouraged to communicate this concern in the following manner: a) Discuss the concern with the person responsible for the assignment on that shift. This person should then assess options and seek to remedy the situation. When no alternatives are identified as possible, the person in charge should contact their immediate supervisor on duty. b) The supervisor should attempt to resolve the situation using available resources as he/she determines appropriate. c) If the nurse is dissatisfied with the decision of the supervisor, the nurse should fill out a complaint form as soon as possible and should make every effort to submit a complaint no later than 24 hours upon the conclusion of their shift. Nurse staffing committees should not interpret this recommendation to submit complaints promptly as a reason to dismiss complaints submitted later than 24 hours after a shift – there is no time limit on submitting complaints to nurse staffing committees. d) If there is no mutually satisfactory resolution to the problem, and the problem appears to be one which will be recurring, the nurse may submit their documentation to the unit or hospital staffing committee (and/or to the nurse’s local bargaining unit, as appropriate). e) Nurses who raise assignment concerns should be free from restraint, interference, discrimination, or reprisal.