Fill out the General SRDF for Non-Acute Care Facilities
NOTE: The SRDF is now only used for those facilities not covered by the staffing law. If you work at an acute care facility covered by the staffing law, complete an OHA complaint form instead.
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COPIES of this form should go to ONA, your employer, your staffing committee or PNCC chair, and keep a copy for yourself.
Online SRDF Submission. You can completed the form online below. The process does include the following steps:
- Complete the form and submit
- You will receive a confirmation email with a completed PDF version of the SRDF attached.
- Please either print or email copies of this SRDF completed form to your employer, your staffing committee or PNCC chair, and keep a copy for yourself.
If you do not receive a confirmation email or have any difficulties throughout the process, contact ONA at SRDF@OregonRN.org or call 503-293-0011.
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SRDF for Providence Home Health and Hospice Nurses
Nurses at Providence Home Health Hospice have a modified version of the Staffing Request and Documentation Form that better reflects the issues they experience regarding staffing and safety.
SRDF for American Red Cross Nurses
If you are an American Red Cross nurse, there is a different SRDF form to use.
- American Red Cross SRDF - to print and mail and/or fax. Mail completed SRDF to ONA at 18765 SW Boones Ferry Road, Suite 200, Tualatin, OR 97062 or fax to ONA at 503-293-0013
SRDF Information
Since 1997, ONA has provided a means by which staff nurses could report when nurse staffing on their unit/shift is insufficient and/or unsafe. The report is part of the ethical obligation of nurses to report when provision of "safe patient care” is, at the least, not supported or at the most, impossible.
When a nurse on a shift is faced with staffing which is imminently or potentially unsafe according to the various causes of unsafe staffing, it is intended that the nurse a) notify someone in the chain of command, b) ask for additional staff, and c) ask for a response in a reasonable period of time, e.g., minutes, hours.
Following this, the nurse assumes the patient care load as assigned, asking for help as he/she needs. At the end of the shift, or within 48 hours, the nurse completes the form, files it with the nurse manager, PNCC, and ONA. The data on the SRDF forms is converted to statistics, and reports are generated.
Definition and Description of a Staffing Problem
- What is important to report
- It is important to report the cause of the insufficient/unsafe staffing
- The number of additional staffing requested
- The turnover of the unit (admissions, discharges, transfers in/out) so that turnover can be evaluated
- Untoward consequences
Declining an Unsafe Nursing Assignment
Prior to taking on any assignment under their license, a nurse must verify they have the knowledge, ability, skills, competencies, and resources to deliver safe client care.
SRDF Summary Reports
Staffing Request and Documentation Forms (SRDF) are filled out by staff nurses or charge nurses at 30 acute care facilities represented by the Oregon Nurses Association (ONA), to document the occurrence of an inappropriate staffing event on a specific shift and unit.
