Florida Nurses Association - OPEIU Local 713

SHANDS
NURSES
UNION

Cell Phone

Number of Nurses on that shift *

If you asked for help, did you get it? How long did it take

Number of "Required" Nurses according to bid shift, if known *

Any falls or incidents during your shift

Unit and Shift *

Did you get a break / Lunch *

Number of patients you were assigned that shift *

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.

The form below and its contents are strictly confidential. All personal information will be redacted.

Do you have any other comments or concerns

Date and time *

Name

Personal Email:

Check here to receive email updates

Was the unsafe staffing situation rectified

The FNA/OPEIU Local 713 is concerned about Safe Staffing. These forms are used to:

Track and identify trends in threats to patient safety that Registered Nurses have reported as a result of unsafe staffing situations
Provide UF Health Shands Nurses Union the information to identify and address these trends with hospital management
Document the actions you took to advocate on the behalf of your patients

Florida Nurses Association - OPEIU Local 713

SHANDS
NURSES
UNION

The FNA/OPEIU Local 713 is concerned about Safe Staffing. These forms are used to:

Track and identify trends in threats to patient safety that Registered Nurses have reported as a result of unsafe staffing situations

Provide UF Health Shands Nurses Union the information to identify and address these trends with hospital management

Document the actions you took to advocate on the behalf of your patients

Please fill out the Safe Staffing form below and the union will contact you.

Safe Staffing Form

Contacts

​​​Florida Nurses Association - OPEIU Local 713

​​SHANDSNURSES​UNION

The FNA/OPEIU Local 713 is concerned about Safe Staffing. These forms are used to:

Track and identify trends in threats to patient safety that Registered Nurses have reported as a result of unsafe staffing situations

Provide UF Health Shands Nurses Union the information to identify and address these trends with hospital management

Document the actions you took to advocate on the behalf of your patients

Please fill out the Safe Staffing form below and the union will contact you.

Safe Staffing Form

Contacts

Florida Nurses Association - OPEIU Local 713

SHANDS
NURSES
UNION