The Professional Performance Committee (PPC) at your Facility 

The PPC is a staff RN-controlled committee, negotiated into every CNA/NNOC contract, with the authority to document unsafe practices and the power to make real changes. Direct-care RNs elect representatives from every major nursing unit to serve on the committee which meets in the hospital on paid time. The PPC tracks unsafe conditions through an independent documentation system called the Assignment Despite Objection form.

The PPC discusses practice and staffing problems on various units, by analyzing the ADOs for trends and recurrent issues. Information requests are submitted as needed, to assure that the committee has all the facts that might be useful in crafting a solution.

As a PPC, you may also elect to report the problem to the appropriate regulatory agencies. RNs and others who blow the whistle on unsafe patient care to outside sources are protected from retaliation under state law (California) and by the contract. In the 1999 California legislative session, the Whistle Blower Protection Act, sponsored by CNA/NNOC, was signed into law. New national whistle-blower protection provisions are included in Senator Barbara Boxers National Nursing Shortage Reform and Patient Advocacy Act S 1031 introduced in May 2009.

The CNA/NNOC Patient Protection Toolbox -Success Stories

Our ability to provide safe, therapeutic, and effective patient care depends on reversing the trend of inadequate hospital staffing driven by corporate healthcare that is putting patients at risk and is driving nurses out of the profession. CNA/NNOC provides nurses with a voice in patient care decisions, which we use to create safe healthcare facilities to protect our patients and our licenses.

Here are a few examples of how RNs in our facilities have used the tools in their toolbox to win improved patient care conditions. These tools include the Professional Performance Committee (PPC), Quality Liaisons (Kaiser), the Assignment Despite Objection (ADO) and the Technology Despite Objection (TDO) forms and the collective action of nurses in your facility.

ADO Campaign Stops Unsafe Floating and Corrects Short Staffing

 "Our manager was regularly floating NICU staff RNs out of the department to the pediatric unit and assigning travelers to work the NICU. We were also out of compliance for staffing ratios at 1:3. The NICU RNs staged an ADO campaign for one week notifying our manager that we objected to the unsafe floating and consistent shortstaffing. Management backed down and floating out of order has ceased. Additional staff have been procured and NICU staffing is back in compliance with ratios." - Lois Sanders, RN, St. Mary Hospital, Apple Valley California

OR Nurses Educate, Agitate, and Eliminate Rotating Shift Proposal

"Our unit director tried to implement a night shift rotation assignment for day shift RNs. "

"RNs were outraged by the announcement. Nurses with more than 22 years of UC service had never been assigned a rotating shift. The announcement further angered the nurses who had endured excessive call and mandatory overtime as a result of chronic short staffing. Working with their nurse representatives, the OR nurses researched the physiological impact rotating shifts have on the circadian rhythms of the nurses, altering nurses shifts has been well documented to increase patient care errors. A delegation of nurses met with management and the result of the meeting was that implementation of rotating shifts was cancelled."   -Manny Punzalan, RN, Chief Nurse Representative/Shop Steward, UCLA Medical Center, California

Refusal of Unsafe Assignment, Citing Title 22, Leads to New Training Program

"An RN from PACU was told she would have to take care of a pediatric patient [infant] on a ventilator. Since the only requirement at the time was for the PACU RNs to be PALS certified, she was the first to point out that the staff nurses were not competent to care for the ventilated pediatric patients. She refused to take the assignment and notified the nurse rep that she faced the potential for disciplinary action. Her knowledge of the law [Title 22] and the unity of the PACU RNs led to an annual skills day with specific patient population competency validation for the unit. As a result, the RN was not disciplined."   - Cathy Kennedy, RN, Quality Liaison, Kaiser Sacramento, California