cfss.mnnurses.orgConcern for Safe Staffing - Minnesota Nurses Association

Safe Staffing Form MNA Blog Member Center Contact Search A union dedicated to advocating for nurses, patients, and quality care in Minnesota, Wisconsin, North Dakota, and Iowa Minnesota Nurses Association Primary NavigationAbout MNA MNA Structure MNA President MNA Executive Director MNA Board of Directors Represented Facilities Map of MNA Represented Facilities Affiliations Careers at MNA History Contact MNA Issues & Advocacy Issues Get Involved How the Legislature Works Take Action Events Action Center Get Involved MNA Student Nurse Day on the Hill Elections Nurses Care Nurses Vote How Elections Work Endorsement Process MNA Candidate Endorsements Racial Diversity Committee News Press Releases Nursing Accent Online MNA Power & Practice Podcast Stay Connected Resources Report Unsafe Staffing Nursing Practice My License Education Education Calendar Twin Cities Pension Loan Forgiveness MNA Foundation Council of Active Retired Nurses Member Benefits Members-Only Discounts and Services Events Calendar Join MNA I Want a Union Why Unions Membership Categories Application for Membership Home Page Concern for Safe Staffing Concern for Safe Staffing According to the MN Nurse Practice Act, you are obligated to advocate for your patients in situations that may threaten their safety. If you have a situation where you feel that unsafe staffing is a concern in your facility, please report it to the appropriate manager/supervisor/administrator at the time that it occurs. MNA also provides you an opportunity to fill out Concern for Safe Staffing forms. These forms are used to: Track Short Staffing which includes numbers of nurses, number of support staff, skill mix and training of staff. Track and identify trends in threats to patient safety that Registered Nurses have reported as a result of unsafe staffing situations Provide MNA the information to identify and address these trends with hospital management Document the actions you took to advocate on the behalf of your patients Provide real life examples of the impacts of unsafe staffing on patients. Any examples selected from CFSS forms will have names, facilities, PHI and any other identifiable information removed. You may choose to provide this form to your manager/supervisor/administrator or not. No one can tell you that you cannot file this form with MNA. The important thing is that you must always notify the immediate supervisor/manager/director when staffing is short and vigorously advocate for safe staffing by reporting unsafe situations at the time it occurs. When filling out this form, please be sure to maintain the privacy of your patients by leaving out specific identifying data and specific patient diagnoses and actions. Thank you for taking the time to document your nursing advocacy. It is important to be as accurate as possible and collect as much information as you can but do not let a lack of specifics deter you from completing the form. Name * First Last Assisted By List the name(s) of any other MNA member(s) who assisted you. Personal Email * A copy of the completed form will automatically be sent to the e-mail address you enter. Please do not use your work provided email addresses. Date * YYYY dash MM dash DD Facility * Select your Facility Abbott Northwestern Hospital Allina Health Faribault Medical Center Alomere Health Avera Marshall Regional Medical Center Buffalo Hospital Cambridge Medical Center CentraCare - Monticello CentraCare - Redwood Hospital Children’s Hospital - Minneapolis Children’s Hospital - St. Paul Chippewa County-Montevideo Hospital Clearwater County Home Care and Hospice Colonial Manor Nursing Home Community Memorial Hospital Cook County North Shore Hospital Cook Hospital Dakota County Public Health Ely-Bloomenson Community Hospital Essentia Health - Brainerd Essentia Health - Deer River Essentia Health - Duluth Miller-Dwan Essentia Health - Moose Lake Essentia Health - Sandstone Essentia Health - St. Mary’s Duluth Essentia Health - St. Mary’s Hospice Unit B Essentia Health - St. Mary’s Superior RNs Essentia Health - Virginia Fairview Lakes Medical Center Fairview Northland Medical Center Fairview Range Regional Health Services Fairview Southdale Hospital Fairview UMMC Riverside Campus Grand Itasca Hospital and Clinic HealthEast - Bethesda LTAC (St. Joe’s) HealthEast - St. John’s Hospital Hennepin County Medical Center Horizon - Douglas County PH Horizon - Granite Falls PH Horizon - Grant County PH Horizon - Pope County PH Horizon - Stevens County PH Horizon - Traverse County PH Hudson Hospital Kinnic Health and Rehab Lake Region Healthcare Lake View Hospital Lakeshore - Ecumen Nursing Home LakeWood Health Center - Baudette Mayo - Albert Lea Mayo - Austin Mayo - Fairmont Mayo - Lake City Mayo - Red Wing McLeod Public Health Mercy Hospital Methodist Hospital Methodist Jennie Edmundson Hospital Mille Lacs County Murray County Medical Center New Ulm Medical Center North Memorial Care Access Triage North Memorial Health Care Owatonna Hospital Perham Health Sanford Phillips Eye Institute Pipestone County Medical Center Rainy Lake Medical Center Refusing an Unsafe Assignment Training Regina Hospital Rice County Public Health Rice Memorial Hospital River Falls Area Hospital Riverwood Healthcare Center Sanford Bagley Medical Center Sanford Bemidji Medical Center Sanford Thief River Falls Medical Center Sanford Worthington Medical Center Sleepy Eye Medical Center Spencer Hospital St. Alexius St. Francis Regional Medical Center St. Gabriel’s Hospital St. Joseph’s - Park Rapids St. Luke’s Hospital State - Health Department State - Human Services State - Veteran’s Home State of MN Stearns County Stevens Community Medical Center United Hospital Unity Hospital UnityPoint - Marshalltown Welia Health WestHealth Winona Health Unit * Hidden Dynamic Facility * Select your Facility Abbott Northwestern Hospital Allina Health Faribault Medical Center Alomere Health Avera Marshall Regional Medical Center Buffalo Hospital Cambridge Medical Center CentraCare - Monticello CentraCare - Redwood Hospital Children’s Hospital - Minneapolis Children’s Hospital - St. Paul Chippewa County-Montevideo Hospital Clearwater County Home Care and Hospice Colonial Manor Nursing Home Community Memorial Hospital Cook County North Shore Hospital Cook Hospital Dakota County Public Health Ely-Bloomenson Community Hospital Essentia Health - Brainerd Essentia Health - Deer River Essentia Health - Duluth Miller-Dwan Essentia Health - Moose Lake Essentia Health - Sandstone Essentia Health - St. Mary’s Duluth Essentia Health - St. Mary’s Hospice Unit B Essentia Health - St. Mary’s Superior RNs Essentia Health - Virginia Fairview Lakes Medical Center Fairview Northland Medical Center Fairview Range Regional Health Services Fairview Southdale Hospital Fairview UMMC Riverside Campus Grand Itasca Hospital and Clinic HealthEast - Bethesda LTAC (St. Joe’s) HealthEast - St. John’s Hospital Hennepin County Medical Center Horizon - Douglas County PH Horizon - Granite Falls PH Horizon - Grant County PH Horizon - Pope County PH Horizon - Stevens County PH Horizon - Traverse County PH Hudson Hospital Kinnic Health and Rehab Lake Region Healthcare Lake View Hospital Lakeshore - Ecumen Nursing Home LakeWood Health Center - Baudette Mayo - Albert Lea Mayo - Austin Mayo - Fairmont Mayo - Lake City Mayo - Red Wing McLeod Public Health Mercy Hospital Methodist Hospital Methodist Jennie Edmundson Hospital Mille Lacs County Murray County Medical Center New Ulm Medical Center North Memorial Care Access Triage North Memorial Health Care Owatonna Hospital Perham Health Sanford Phillips Eye Institute Pipestone County Medical Center Rainy Lake Medical Center Refusing an Unsafe Assignment Training Regina Hospital Rice County Public Health Rice Memorial Hospital River Falls Area Hospital Riverwood Healthcare Center Sanford Bagley Medical Center Sanford Bemidji Medical Center Sanford Thief River Falls Medical Center Sanford Worthington Medical...