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Resource Category: POA

Why Fill Out a Protest Of Assignment (POA)?

How Many times have you heard a manager say, “If it wasn’t Documented, It Wasn’t Done”

Well, This is No Different!

We need to know what is happening To You, With You & Around You!

Filling out a POA makes that Visible.

  • Protect Your License: POA’s are recognized in a court of law; they do not need to be “accepted” to be valid.
  • Document Unsafe Conditions: Staffing issues, lack of resources, patient acuity all need to be recorded.
  • Strengthen Your Voice: Whether you file one alone or with your team, every POA counts.
  • Hold Management Accountable: This is how we build a case for change. Keep a copy of your POA for your records—bring it to any discipline meeting.
  • Safety in Numbers: One POA is important, but many POAs create undeniable patterns.

When We All Document – We Build Power
When We All Speak Up – We Create Change

The Union Views a CNA on a 1:1 = Non Compliant PCM

NO CNA • No Secretary • Overstaffing Ratio

You MUST fill out a POA and a PSI.

If you are floated to the Tele Booth – ED & 4th Floor, make sure you put it in the FLOAT book & fill out a POA.

Email POA: BMHhealthcare@aftunited.org • Fax: 7334

Protest of Assignment Form

    Protest of Assignment

    Person Filing Protest
    Assignment Details

    Staffing

    Staff
    House PA
    RT
    RN
    CNA
    Secretary
    # working
    # supposed to be working

    Patient / Unit Activity

    Supervisor Notification
    Factors Affecting Ability to Provide Safe Patient Care

    Select all that apply.

    Signature

    As a patient advocate, in accordance with the Nurse Practices Act, this is to confirm that I/we notified you that, in my/our professional judgment, my/our assignment is unsafe & places my/our patients at risk. I have been mandated to provide care and do not want to abandon my patient. As a result, the facility is responsible for any adverse effects on patient care.

    What Is A Protest Of Assignment (POA)?

    A POA Is Not A Refusal — You Are Still Accepting The Assignment

    The Official POA Statement

    “As a patient advocate, in accordance with the Nurse Practice Act, this is to confirm that I/we notified you that in my/our professional judgment, my/our assignment is unsafe and places my/our patients at risk. I have been mandated to provide care and do not want to abandon my patient. As a result, the facility is responsible for any adverse effects on patient care.”

    Why It Matters

    1
    Creates an official paper trail
    2
    Protects your license & minimizes litigation risk to you
    3
    Documents what's missing: CNA, Secretary, short staff, etc.

    Common Reasons To File (Not Just Ratios)

    • Not enough RNs, CNAs, or secretaries on the unit
    • Patient acuity higher than usual
    • Floated without orientation to the unit
    • Mandated beyond your shift
    • Missing equipment or supplies
    • Missed breaks or meals

    Full checklist of factors is on the actual POA form — check all that apply.

    How To File

    1. Ideally, complete the form before end of shift — check all factors that apply.
    2. If you can’t, complete it as soon as you can after your shift.
    3. Notify your Supervisor/Manager as early as possible & get signatures.
    4. Email to BMHhealthcare@aftunited.org and fax to nursing office (7334)

    If Your Manager Won’t Sign — Write “Verbally Refused By [Name]” On The Signature Line

    A refusal to sign does not invalidate your protest. Your paper trail still stands — and it’s what lets the union prove, in real time, when you were mandated beyond your shift, missing equipment or supplies, carrying more patients than usual, or working without orientation to the unit. Document it. Protect yourself. We can only fight for you with proof.

    For Nurses: Staffing Variation POAs Require A PSI Too

    If your POA is reporting a staffing variation, you must also file a PSI — write the PSI number directly on your POA. A PSI can be filed at any time during your shift, regardless of what leadership tells you.