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oklahoma nurses association c.a.r.e.s program

Concern for Assignment Form

The Concern for Assignment Form is one strategy nurses can use to voice their concerns regarding patient care. It works well in initiating discussion with supervisors when concerns for patient safety exist.

During a staff shortage, the management team has usually worked diligently to find a solution. Your goal is to communicate your concerns for patient safety factually and calmly while working to assist in finding a workable solution to a difficult situation.

The Concern for Assignment Form helps to document the information needed. The completed form may be given to your supervisor. It is to help you in documenting your concerns.  The information documented should be accurate.

Communicating Your Concern for Assignment

Consider this scenario: You arrive on your unit to begin your shift and find that staffing levels are insufficient to safely provide for patient care. As a registered nurse, you have a legal and ethical responsibility to provide safe and effective nursing care and to voice your concerns through institutional channels. The following are steps in communicating your care regarding an assignment:

Communicate:  Report the issue to your immediate supervisor:

    • State your concerns clearly
    • Be specific about staffing needs related to census and patient acuity
    • Collaborate and cooperate to problem solve
    • Offer alternative solutions to the dilemma
    • Give your supervisor time to respond
    • Remain calm, keep your emotions in check

Authenticate: If your supervisor cannot revise staffing, and you continue to have concerns about patient safety, you should: 

    • Remain on your unit in order to not further compromise patient safety
    • Document all discussions with your supervisor and others in regard to the situation
    • Document details of your request for additional personnel, the supervisor to whole you reported and the response to your request
    • Use the Concern for Assignment Form

Remain: To leave your assignment rather than stay and contribute to patient care could result in:

    • Serious Consequences!
    • Further jeopardizing patient safety
    • Being reported to the Board of Nursing for violation of the Nurse Practice Act
    • Disciplinary action by your employer up to and including termination

E - Ensure:  Ensure the safest patient care possible:

    • Prioritize essential patient care
    • Collaborate with your team in making patient care assignments
    • Delegate appropriately
    • Provide ongoing feedback to your supervisor regarding changes in the situation

If you need consultation on appropriate responses to staffing or other workplace issues, contact the Oklahoma Nurses Association at (405) 840-3476


Supervisor Response to Staff Concern for Assignment

 Staffing and patient care issues are often fraught with emotion – for staff and manager.  The following suggestions may assist you to respond alive to your staff:

A – Assess
    • Review the concern presented to you
    • Be solution focused
    • Assist staff member to work past anger, frustration and guilt to communication, understanding and collaboration
    • Keep your emotions in check – defensiveness, anger and hostility can antagonize the situation


L – Listen
    • Establish an environment that facilitates dialogue and collaboration
    • Listen with an open mind to the staff’s concern
    • Assist staff to understand the constraints, actions already taken and the options still available


I – Intervene
    • Help staff learn from difficult situations – analyze what worked, what needs to be improved….teach staff to do this regularly


V – Value
    • Avoid personalizing the situation – you did your best and things didn’t work out – now, how can we prevent this from happening again?
    • Be open to new ideas – encourage new ways of thinking about difficult situations

E - Encourage
    • Pull your team together to negotiate a safe solution to the staffing dilemma
    • Collaborate on how to get through the shift – set priorities, delegate, call your next level of management


Document the situation. If you need assistance or have questions, contact the Oklahoma Nurses Association at (405) 840-3476.

6608 N. Western, #627 | Oklahoma City, OK 73116

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