NYSNA COVID & Staffing Diary

NYSNA needs to hear from all members regarding the conditions in your hospital during this Omicron crisis period.

Documenting inadequate staffing and other unsafe conditions can help protect yourself, our practice, and our patients.

Your report is not anonymous due to the nature of this service. However, NYSNA will not use your name or contact info for any report we generate, nor will we share it with your employer or any third party.

We will email you a copy of this form. Please save it for your records.

You have my permission to send my diary entry to the NYS Department of Health. I understand that my name and the name of my facility will be included in my report to the DOH.

Your name

Your Email

Mobile Number

Facility

Work Area

Describe your COVID experience or your most recent shift. Be sure to include any details that you think are relevant to safe staffing, your personal health and safety, and the health of your colleagues and patients.

Do not provide any individually identifiable health information protected under HIPAA in this section.

May NYSNA contact you about using your experience to advocate for our practice with lawmakers and the press?

YesNo

COVID-related conditions

Did you treat COVID patients today?

Were you provided with adequate PPE?

Adequate PPE for treating COVID-positive patients includes an N95 (or higher level) filtering respirator, of the size and make fit tested for, worn for one patient care session; a fluid-resistant or impermeable gown; gloves; and goggles or face shield.

If your PPE was inadequate, please describe how:

Staffing

Total number of nurses on your unit today

Total number of patients

How many of the nurses assigned to your unit are properly trained or oriented to take a full assignment on the unit?