What/How do I delegate to the CNA?

november17, ASN, RN · Sep 15, 2008

The first step is good communication. You're part of a team. A team is nothing without communication.

If you're waiting to delegate without being a b-word, you're waiting too long. You need to open those lines. Get to know the CNAs you work with. Learn their strengths and weaknesses. Ask about their kids, their hobbies, etc, whatever. Talk to them, listen to the conversations between them and join in. That's just opening the door to good communication. Get comfortable with the people you work with.

WVStarFish · Sep 15, 2008

I get along great with them, I'm just not used to being "in charge" of anything. And I have no idea what to expect from them. But as for getting to know everyone, we all get along great for the most part.

Virgo_RN, BSN, RN · Sep 15, 2008

When I worked in LTC as a CNA, the CNAs did all the direct patient care, with the exception of RN tasks, such as tube feedings and neb treatments, etc. We were expected to answer call lights, assist residents with bathing, ambulating, toileting, etc. On the rehabilitation wing, the nurse would give us a list of vitals to do, in addition to everything already mentioned.

RNfaster · Sep 15, 2008

I am working as a CNA to help me be better prepared for nursing school and a better nurse. I have worked in three different environments and believe the following are vital to good teamwork:

1) active management

2) adequate ratios for techs and nurses

3) good, working equipment

4) good unit design (I prefer circular)

5) good relationships with other departments (e.g., lab, respiratory, physical therapy)

6) enforcement of facility rules

7) staff education

8) staff empowerment

I don't mind taking requests from the nurses. I do mind when I see them chit-chatting and/or surfing the web and dumping on me (this hasn't happened in my new workplace - the nurses are great). I especially like opportunities to team with the nurse and learn and/or deliver great customer service. I like it when the nurses team with me and don't take the attitude that they are better than me (in the past, I have run into that... --I have had some say (when I am running around like crazy and they aren't busy, I have a bachelor's degree and I didn't get it to toilet someone.) (Well, I have a bachelor's degree, too, and I plan on having another one, and a master's degree, and if I have to toilet someone because the tech is busy, I will...)

I think if you are in an environment where you have too many patients and the techs have too many patients, they may be pushing back because of the load. If that's the case, I'd move on to a better facility. If you must stay is such an environment, I'd try to let the techs know that you appreciate them. Say thanks at the end of a shift. I have started doing this to my teammates.

I think a lot of the troubles relative to attitudes are due to understaffing and inadequate pay.

Good luck!

classicdame, MSN, EdD · Sep 15, 2008

I recommend you review the nurse practice act for your state. It may be found online, as many are these days. This should tell you what you can delegate. The Texas NPA even has a decision tree for delegation. This might help. But as for getting someone to do their job --that is another matter. If you are fair and consistent that will show thru and you may get more teamwork. I believe the CNA's work harder than anyone. Show them you appreciate that. But, don't take any smack either.

CoffeeRTC, BSN, RN · Sep 15, 2008

This might be best in the LTC forum.

In LTC the CNAs do the bulk of the hands on care. They are responsible for all of the ADLS, feeding, toileting, changing/ dressing and transfering residents. Generally, they apply splints or positioners, turn and repo every 2 hrs and vitals.

As you know, most CNAs are extremly busy. If the pt needs something and you are unable to provide it or they can wait, I will let the CNA know that so and so needs XYZ.

Meriwhen, ASN, BSN, MSN, RN · Sep 15, 2008

From my non-nursing workplace experience: never delegate something that you're not willing to do yourself. I always followed that rule with my subordinates and while I may not always have been liked, I was always respected because when it came down it it, I wouldn't pull rank but instead do whatever was necessary to help get the job done. And that got them doing their jobs.

It showed respect for my subordinates...and that's the same attitude I plan to have when I become an RN. If you want to assign the ADLs and such to the CNAs, that's fine--but like other posters have said, don't dump the grunt work on them so you can get off easy...nor should you take the attitude that such tasks are "beneath you" because you're an RN and refuse to pitch in when it's needed.

And like others have said, foster communication but let them know what is expected from them.

CoffeeRTC, BSN, RN · Sep 15, 2008

Okay....I tend to agree with the..I wouldn't ask you to do anything I wouldn't BUT...doing adls, toileting, feeding etc it the CNAs JOB. I work with a great bunch, rarely do I ever need to ask them to do something...they anticipate the needs and for the most part are a great staff.

As far as delegating....first you need to know what the job duties are of the person you delegate to. What are they able to do? You must also look at the strength of the person. I have one CNA that is great at calming agitated residents and another one that gives a great shave.

I will always help out when needed. I am a nurse first and formost. If anything sets me off the most, it is the nurse that will hunt down a CNA so that they can give the resident a sip of water, transfer them etc when they could have done the same thing in like two minutes themselves.

Getting back to the OP questions...

You should expect the staff to do their jobs to their best abilities. Unless they are new staff...they know what they need to do. If there are any new tasks for the day (weights, moving a room, etc or tasks that need to be assigned) it is your job to communicate that to them at the start of the shift or ASAP. Everyone I work with knows what I expect and I know what I can expect from them....ask for help before things get backed up.

As far as not being able to find CNAs...where are they? Are they in rooms doing care? feeding? on break? ??????

woknblues · Sep 16, 2008

There is a proper flow for this scenario. Too many people jump over critical steps and end up in bigger poo than when they started.

First, you try to resolve the problem up front. The "B" terminology gets thrown around a lot by people who are bitter, lazy, unhappy, unfulfilled, etc. They are the CC (constant complainers) in the shop/unit that drag everybody down. These will also be the "not in my job description" types, not talking about doing something you are not qualified to do, but rather they just don't want to do it.

OK, so we have identified your antagonist, now you have to evaluate her/his cohorts. Many times, you can recruit from their "support group" and win them over with group mentality.

Once you know who, now you have to figure out what is it that they are doing wrong, and what it takes to get it right. Make sure that you are within the boundaries set by your facility and license, of course. Be inclusive in your evaluation of the situation so that you are interfaced with the program directly, and not just a superior observer.

Then, and most critical, is the sales pitch. It can be a "hard sell" (formal, in a scheduled group meeting) or "soft sell"(during the next lunch break). Depending on your position, you may wish to make management aware of your intentions, but it will be tricky to do this properly, because you could be perceived as a snitch, or a backstabber. It is a fine line, and only your situation can really point to your choice on this.

If at this point, you get eye rolling, more negative comments, and you feel that you cannot follow through with your goals, document very well, DON'T BE SPITEFUL, and meet with your management to discuss how to improve your situation. Refrain from mentioning names. Just focus on the situation at hand. Be sure to offer all of your solutions to the problem. The worst thing you could do is to just unload problems onto a managers desk, and let them deal with it. You could be pulled in to a room with the offender, and a group of people looking at the two of you like you are both in the same boat.

Best of luck.

pagandeva2000, LPN · Sep 16, 2008

First, you need a copy of their scope of practice and job descriptions. While I certainly believe that nurses can assist CNAs, it must be remembered that while the nurse can do the CNA job, the CNA cannot do all of the skills of the nurse. I would begin by showing that I am not above doing certain things like placing a patient on the toilet (and make sure you tell the CNA that you did this), getting some water, etc... But, I can understand your dilemma, especially as a new nurse who is still getting herself organized. Make sure that there is an assignment posted and if you can let them know of changes as soon as you can. Check every now and then to see how they are doing, and also try to foster teamwork between them. Many times, they feel overwhelmed, because one is hiding while the others are killing themselves. Maybe a buddy system? I don't know many of the answers because LPNs function quite differently in hospitals-we aren't the ones making assignments. It is the RNs that do it where I am, and I haven't done LTC yet. I do feel for you, though.

IVqueen23 · Jul 26, 2012

I would write their A$$es up!! over and over and over again until they complied with the regulations. Check your policy but I'm pretty sure that after three write ups they can be fired. Talk to your DNS or RN supervisor for support and you can give them all a verbal warning if you feel as though things need to change.