How do you handle delegating to PCA's?

[missdeevah]

i am curious to know how other nurses out there handle delegating tasks to pca's. i'm always very polite in asking (not commanding). i would say, "ms pca, would you please put some scd's on pt in room 123?" i do try to do tasks like these when i can. but if i have to 2 things that both need to be done, one of which can only be done by a nurse, then i will delegate the other task to a pca. i do help patients up to the bsc or bathroom, help with repositioning in bed, get them ice, water, snacks, etc.

my shift starts @ 1900. there's a pca a few days ago whom i asked to put scd's on a pt. she looks at me and says nothing (she has this habit of not responding when asked to do tasks by nurses). almost 2 hrs later, around 2245 nothing has been done regarding the scd's. at this point i had already gotten 1 admission, had a transfer that had arrived right before shift change, and i had been informed that i was getting another admission, though the charge would help me with doing the actual admission paperwork. so, later i find the cna sitting @ the nurses' station as i'm running around trying to take care of my 5 patients. i remind the cna, as she looks like she is getting ready to leave. at this point, i'm on my way to do my admission paperwork on the first admission. she walks away, then turns around, throws her hands in the air and says loudly, "you don't know how to do it?" then walks away. later, after she has left, i find that she has put foot pumps on the patient. the week before there had been a big issue with a pt that had scd's on, that had not been ordered, and due to the pt's illness, scd's were actually a contra-indication. so i wondered whether she was trying to set me up, or had this been an honest mistake?

what kind of tasks do you delegate? how would you have handled the above situation? i would like to point out that the pca in question is quite a bit older than i am, has been at the job for several years, and the day before was making a big scene @ the nurses' station about how nurses have yelled at her and how people like running to the manager to complain about her.

[suejara]

It's hard to work in a "team" when one person doesn't do their fair share. Maybe it is something as simple as this PCA being older than you or thinking that you delegated a task that "is beneath you." I once had a new nurse announce that she didn't go to nursing school to learn how to wipe behinds.

I worked in a hospital as a PCA where many of the PCA's were older & had been on the unit longer than most of the nurses, they often were a little defensive and rude, especially when they felt unappreciated.

You shouldn't have to work on eggshells around her but perhaps you can rephrase the way you ask her to do tasks...maybe say "I need for you to do________ while I am starting an IV for patient______".

However, I think you should stop her dead in her tracks when she disrespects by asking if you don't know how to do something. Such behavior cannot be tolerated.

[nurse12b]

I am in nursing student and I have been a CNA/PCA for the past 10yrs. I know there are alot of aids out there that are really lazy and are not worth a hoot. However, in reading the post that she had put foot pumps on a pt that it was contraindicated on, maybe she needs more teaching.

I do agree with one of the post by giving her a time limit to have it done by,

I remember one of the times I got in troble, was I was supposed to collect the I&O's by 1400, but the problem was I was an agency PCA and I did not know that they needed to be done by 1400 and I told the nurse that, but from then on the nurse was on my butt the whole time I was there.

Most of the time where I worked there were alot of nurses and just me as the PCA and I never got to sit and all the nurses were sitting and chatting. So it goes around both ways.

No, she did not need to respond to you that way.

But, I can say that I have said that to a nurse before but it was a differant situation, where I had 30 pts bymyself and there were 6 nurses that night. The nurse had asked me to do something several times while I was in another pts room cleaning up a butt explosion (by myself). So I told her "CAN"T YOU DO IT"! Yes, I could have been nicer about it, come on look what I was doing, its not like I could have told the pt I will be back to clean you up after I do something else.

[RescueNinja]

I don't really have any advice for you, but I just wanted to chime in and say I know how you feel. As a student we never really delegated to the UCPs per se, but any time I would ask for help with 2-person transfers or whatever they'd tell me they were too busy or they'd just roll their eyes and say things like "you're the nurse, you must know how to do it better than us!"

When I worked at my LTC job as an aide through school the other aides would be nice to me until they found out I was a SN then they totally ignored me and made snotty comments. I always do my best to be nice to everyone and most people that know me say I have a really sweet personality so I figured it to be jealousy on their part and tried to do my best to just get my work done without them unless I absolutely needed help (like those two person transfers). I told a couple of the nurses how the other aides were treating me one day when it was really bad and they told me that they were like that to all SNs and they started to help with the necessary things when they could. Almost everyone in my class that worked as an aide in LTC had this type of behaviour directed toward them. It's really awful.

Now that I'm starting as a RN in LTC I'm worried about delegating tasks as almost ALL of the aides will be older than me (I'm 22) and I think that's a major factor in this. Hugs to you, I hope it gets better. I'd probably talk to my DON for more direction if I was in your shoes. Good luck!

[eriksoln, BSN, RN]

I was a CNA while I was in nursing school. Did a very large paper on just this subject.........well, more the "Legal aspects of Delegation" than anything but it had a lot in it about nurse/CNA relationships in it.

While I was a Travel Nurse, I quickly learned the best way to survive the first two weeks of each new assignment was to befriend.............guess who? The other RNs...........eh, not as much. The Unit Manager.........eh, not at all really. The Hospital Supervisors.........no, had assisgnements where I never even spoke to one to be honest. The answer is............the CNAs.

With them on my side, I could get the pt. care done and then I had time (with no call bells going off) to make sure the paperwork side of things was in order.

My point is, I take my relations with the CNA's I work beside very seriously. I choose to make getting along with them a top priority still today. Now, some CNA's are just not interested in anything other than getting the vitals completed and charted so they can go hide. Not a lot one can do with them, there is nothing to work with there. Some CNA positions are difficult to fill and they throw any warm body onto the schedule and call them a CNA regardless of how poorly they do on the job.

There is no car salesmanship to it or any way around it. If you want to get along with the CNA's, you have to put some effort into it. Some are self motivated and will love you for helping them. Others take a little more. Do whatever it takes to create a good working relation with as many of them as possible and you will see the results of this show in the pt. care you give.

When I was a travel nurse, I often bought lunch for my CNA (we did team assignments, one CNA for each RN, both with the same assignment). I had one that had to leave the unit to smoke, she just couldn't handle 8 hrs without smoking. But, she only did it once and was gone like, eh........20 min. So, I didn't give her a hard time, covered things while she was gone and she always returned re-energized and ready to do w/e needed. One CNA who, lol, accidentally put diesel fuel in her car and thus found herself without transportation, got rides home from me instead of waiting for the bus if we worked the same shift. It takes going the extra mile but you will be glad you did.

[shiccy]

We had an aid that totally refused to do her job as she was suppose to, stomped her feet and complained when you asked her what a blood sugar was (b/c she didn't chart it and it was MN and the coverage was due at 2200), refused to empty foleys (she said she would forget, but after physically ASKING her three times and it STILL not being done on ANY of her patients, etc. She ended up getting talked to multiple times b/c we brought it to the supervisors, got an attitude, and was no longer employed. I believe she "quit", but ...

End result, if you ask for something to be done and it's NOT done and it's a purposeful thing, then it's something that needs to be brought to the attention of the higher ups.

The thing to consider, however, is if it is only happening to you. If so, be mindful of the reprocussions. Also, contrary to what others are saying on here, MOST people will accept criticism in a NON-CONFRONTATIONAL way.

Please be mindful that I have the utmost respect for the aids that work with me. Most or all of them do the things that I request. This being said, if an aid were to look at me and NOT acknowledge me, that's outright disrespect, and in my mind that is NOT acceptable behavior. If you want to kick this attitude in the rear, I suggest trying this technique verbatim: "Hey (aid's name), when you get a chance, can you put some EPC cuffs on room 2222?" If you are looked at and not acknowledged, you MUST add, "So ... is that a yes, or did you not hear me?" This FORCES her to acknowledge you. If she says, "YES FINE!" and does not do her delegated task, THEN bring it to the attention of supervisors.

Chances are if she is complaining about the other RN's complaining about her attitude, it's probably not something new for them what-so-ever, and it's probably already documented. It works HUGELY in your favor, however, to say, "She acknowledged my instructions" in a situation like this.

I'm glad the aids on our floor do a great job ... it makes the floor flow so much more smoothly!

[msn10]

In my utopian, unrealistic, perfect nursing world I would like to see PCA/CNA's involved in report before each shift. I think it would show them how important they are to patient care and would get them more involved as stakeholders in the process.

[nurse12b]

I can tell you one time while i was doing my first semester clinicals in NS, we basicly followed the PCA. While on this one floor there were 3 of us nursing students and 2 PCA's, and of course they loved us for doing there work for them, for they were no where to be found while we were there.

Well on this particular day one of the other NS had an opportunity to go to the cath lab with her pt and that was right after we got there and we told the PCA that she would not be able to take her share of the VS and she would have to do them. Well the other NS came back at 1345 and we had to leave at 1400 and she still had alot of paperwork to do on her pt. Well the PCA came in and said "are you going to do the VS now" and she told her that she couldn't because she had paperwork to do and we had to leave. And she told her that she was not going to be able to do them 5hrs ago. So the 0800 VS and the 1100 VS were not done at all for that group. Well the PCA goes and tell's the charge nurse the we did not know how to do VS and she come into where we are at and yells at us "WHO in here does not know how to do VS" and we just looked at her shocked. I said, that is not what we said and I told her what had happened and then the PCA got in trouble.

I hated that, that had to happen but I did not know that the PCA did not do the VS and if she would have asked I would have helped her. I was a PCA once myself and know how it is. Accually I like takeing VS (strange I know).

[missdeevah, NP]

sorry, it has taken me a little bit to get back here as i was working, then asleep...you know the drill

i would like to start off by thanking all of you for posting different suggestions, constructive criticism and just general input. i am always very respectful in the way that i ask...both with the words that i use, and with the tone of my voice as well as with my affect. i did ask the pca the first time, including using the words, "when you get a chance." i was hurrying up and down the hall, not having sat down or stopped to chit-chat by this time. i have mentioned before on this forum about how busy my floor is, and that i am busy from start to finish on almost every shift. like i did mention in this thread, i do perform a lof of tasks that i could easily delegate to the pca's, when i get a chance, and even a lot of times, when i really have a lot of other tasks waiting that only a licensed nurse can do. i do get along well with all the pca's. i do make a point of acknowledging and greeting all the pca's and nurses that i work with when i first see them during the shift. i definitely acknowledge tasks done by pca's when i delegate, and often use the words, " i really appreciate you doing xyz." i will often ask the pca's working with my assigned patients to let me know if they need help with "moving pt in room 123 with moving up in bed, cleaning them etc." i also without letting the pca know (after all, why should i announce that i have assisted pt in room 123 go to the bathroom. after all, when they see additional i/o written down, they know that i did it), do tasks that i could delegate. i often will hear a pca say, oh, it's ok, i'll do that. and i let them know that it's ok, i will do it (if i can). i never delegate because a task is "beneath me." i'm aware that we are all there to work as a team, and for the most part we all are. i do ask other nurses if they need help, if they appear to be drowning, just as they do with me. if i'm walking down the hall and i hear a pump beeping, i try (though not always) to stop and take care of it for other nurses, as they do the same for my patients. i've actually been pretty bad about not delegating and realized i was ending up leaving much later than i should as a result. i'm learning not only to delegate, but to pass on anything that i was honestly not able to complete in my shift, despite my honest best efforts, to the next shift, and learning not to feel bad about it. i also take in stride when the previous shift leaves some things undone, because i realize that we just can't always do it all. it still resonates in my mind, the words that one of my wonderful preceptors told me..."it's part of the continuum of nursing care." i've also learned to sto and take my lunch or a break at every shift. i'm learning that there will always be something that needs to be done, and life on the floor will go on, whether i stop and take a break (at an opportune time) or not. i just can't do it all, especially not by myself.

one thing that i have got from the responses is that i should give a timeline of by when delegated tasks should be done. it may also be useful to say, please do xyz, while i do abc. i should probably speak with my manager or supervisor about this incident, and how to better handle or deal with such situations. like i stated...this pca does tend to have an attitude, part of the reason people have complained to the manager about her. i do plan on stopping her immediately and addressing the issue @ hand as soon as it happens (in a respectful manner)

and last but not least...thanks for the empathy (both from the nurses and the pca's), and for the hug thast someone sent me. thanks! more suggestions and condtructive criticism is welcome :)

[jerenemarie]

Long Term Care nurses must supervise/delegate...facilities have been cited for lack of supervision during a state survey. And DON's must back up licensed staff for supervising...I feel this is a big issue! It is very frustrating, not to mention disrespectful & rude, for a DON not to back up nurses when the need arises to discipline unlicensed staff! Supervising is not easy, it doesn't happen overnight, but when nursing administration is there to back you up it makes it a heck of alot easier!