Dear CRONA Nurses,

Some of the stories coming from the new 500P units are alarming. If your staffing is low, you are going out of ratio to take breaks, or have other staffing issues, please let CRONA know about it. More importantly, seek assistance in real time and file an Assignment Despite Objection form.

Thank you to the nurses who have submitted ADOs. Some Nurses have been speaking up. They now have the attention of CRONA and their top nursing leadership, and help is coming.

CRONA Nurses, your senior leadership will not hear your concerns unless you report them. Your ADOs bring your concerns to the top level of Nursing administration and help CRONA leadership be more effective voicing your concerns to the hospital.

You, CRONA Nurse, must take action. Complaining to your friends and coworkers is not enough to solve any problems. Complaining to CRONA without filing an ADO does not provide CRONA leadership with the data we need to represent your concerns effectively. When your complaints don’t make it outside the break room, no one with the power to effect change will hear you.

It is the holiday season, flu season, and short staffing in the new hospital. This should also be the busiest season for filing ADOs. Our patients deserve for us to give our best, and giving our best means speaking up when something isn’t right. Do the right thing – for your patients, for your nursing practice, for your coworkers – speak up! When your assignment or your unit is out of ratio by patient acuity or number of patients – including during your breaks and meal breaks – you are not providing the safe patient care demanded by law.

In Unity,

Colleen Borges, President



Know the law:

Title 22, Division 5, Chapter 1, Article 3, Subsection 70217

SB-227 Health and care facilities: inspections and penalties

Read this article on breaks


Assignment Despite Objection Q&A

Q: What is an ADO (Assignment Despite Objection) for?

A: It is an important way to notify CRONA and the hospital about issues so that we can find ways to solve problems. To call attention to issues above unit level and seek help in real time.

Q: When should I seek notify someone about a problem?

A: In real time, as soon as you notice the issue is the best time.

Q: Who do I notify?

A: If you are not the Resource Nurse, notify the Resource Nurse. If you are the Resource Nurse, notify the Nursing Supervisor and your manager on call. If you do not receive an appropriate response, go up the next level of your chain of command.

Q: When do I tell someone that I am going to file an ADO?

A: This should be part of the conversation when you report the problem. ADOs are not intended to be punitive, they are intended to help solve problems at a higher level. Notify someone when you realize you are in a situation for which an ADO is appropriate – this gives your Resource or manager an opportunity to correct the issue. Even if the situation is corrected, it is still useful to file the ADO to track the issue and to give CRONA and Nursing leadership the opportunity to look at the issue in case it applies to other areas or there is a way to improve a system.

Q: When do I fill out the form?

A: As soon as you are able to, ideally by the end of your shift or right after your shift.

Q: What do I include in the ADO?

A: The issue, who and when your reported the issue, and what was the response when you reported the issue. Examples of types of issues for ADOs:

  • Violation of staffing ratios, by either acuity or number of patients, including during breaks.
  • Inadequate staff for patient acuity
  • Equipment and/or supplies inadequate for patient care
  • Not trained or experienced in the area assigned
  • Patients were admitted or transferred without adequate staff to care for them
  • Involuntarily required to work beyond scheduled shift

Remember, if you are an ICU nurse in a 1:1 patient assignment, only a nurse with no other patient responsibilities can give you a break within ratio. If you are an ICU nurse with any patient assignment, you may not cover a break – even 15 minutes – for a nurse with a 1:1 assignment. ICU nurses, please stop covering each others’ breaks in violation of Title 22 acuity and staffing ratios.

Q: Where do I send the ADO?

A: Send to CRONA via email to or fax to CRONA (650) 366-0182. Leave a copy of the ADO for your manager.

Q: Where can I learn more about staffing, Title 22 staffing ratios, breaks, and SB 227 fines for hospitals that violate staffing ratios?

A: Read the most recent CRONA Newsletter, HERE.

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