How to deal with nurses who respond they are busy when you delegate

Sun0408, ASN, RN · Jan 29, 2013

What type of facility is this?? I would caution you, are new to nursing with minimal experience and now you are in a new job/role.. Tread lightly, you don't want to come off as a know it all. You have mentioned here they lack knowledge and critical thinking to name a few, the staff may sense this..Are these care plans written or computer generated based on admitting dx.. If I had 15 pts I was responsible for in a 8-12 hour day with meds, tx, issues etc.. I can see why they can't "create" a care plan however, printing and signing is easier and doable with the pt load. Is there any "fluff" in the job that can be cut so the staff has time to do the required documentation?? Maybe you can have a meeting. Hopefully that would be a good way to get to know the staff and learn some of their issues.

biju27 · Jan 29, 2013

Thank you for your response. I am a manager on subacute unit. I apologize if I sounded as a nurse who knows it all but I do not present myself as one. I constantly evaluate my performance, and always find something new to read about and learn. What you would think about a nurse with the following examples. I am talking about a nurse who have at least 20 years experience. For example, a patient fell and is on the floor, the nurse will not consider it as an emergency and continue with passing the meds. The nurse will flag any labs for the doctor to seeat a later time, even when the potassium is very low. The nurse wil come and ask me what to do with BP meds even when the BP is 80/40. I can give many examples. I will explain to the nurse what she should do, the next day the situation will be the same. I have met with the staff already, but I am planning to meet with the nurses alone. Thank you for your help.

Sun0408, ASN, RN · Jan 29, 2013

With the examples you state, its hard to get a handle on.. A fall is priority over meds. The K, well how low, what is the pts norm, are they symptomatic.. It all plays a role whether I call at 4am or wait til rounds. The BP situation should be turned over to the MD for them to decide as it is outside our scope to hold without and order. Some cardio docs still want the med to be given, depending on why the med was ordered.. Parameters should be put on all meds, takes a lot of the guessing out of it and a lot of late phone calls to MD's :) I have had some write to hold for SBP less than 70 only or hold if HR in the 40s. Of course it all depends on the reason behind the medication.

I thought this was about care plans LOL, you have some issues but sounds pretty typical of acute care as well.. Educate educate educate.... When in doubt call the Doc. It might **** them off but the staff will learn and cover themselves in the process and the docs will learn to write parameters hehe :)

NotFlo · Jan 29, 2013

I'm a floor nurse on a subacute unit. I can have anywhere from 15-25 patients depending on staffing and census. I would never in a million years have time to do all my patient's care plans. My unit manager does them. I have had five unit managers over the years in my current job and all of them have done the care plans. I might update them if a patient falls and I'm adding interventions or develops an infection or something but I'm not required to. The initial care plans are always done by the unit manager.

What are your duties as unit manager? My unit manager and I and the other nurses work as a team. It helps that it is obvious that she respects and values us. When we are really in a jam she is out there answering lights. When we are desperately short she pushes the med cart. Likewise when she is swamped I am there to help pick up the care plans or run to a family meeting or call the labs in to the doctor or whatever else I can do to help.

HouTx, BSN, MSN, EdD · Jan 29, 2013

Hmm - (trying not to be negative here). Full disclosure: I'm a nurse educator - past jobs include management/administrative roles in a variety of clinical and educational environments.

The information that jumped out at me from the OP's post was the lack of appropriate response to patient situations. This behavior was not acceptable for an RN - or LP/VN. Unfortunately, if this individual has 20 years of experience, chances of transforming them into a critical thinker is very slim. The common mis-perception is more experience=more expertise. BUT that is only if the person actually learns from experience & some people don't. They just repeat 'year one' over and over again.

I would advise the OP to address these glaring examples of disregard for patient safety ASAP. If possible, obtain a diagnostic competency assessment to determine whether there is actually a knowledge deficit present. If so, this may(!) be correctable with additional education. If there is no underlying lack of knowledge, then the problem can only be addressed through progressive counseling leading to discipline. Termination may be an outcome. The consequences for lack of improvement need to be made very clear.

Orca, ADN, ASN, RN · Jan 29, 2013

As a result, I do all of thier paper work. It is overwhelming for onr person to do all, especially when I have families that are very demanding and expect from me to update them about their relatives on daily basis.

This jumped out at me. Your subordinates have apparently realized that if they blow you off, you will do their work for them.

In this situation I would resort to counselings, proceeding to letters of instruction and finally to written reprimands if they continue to be non-compliant. I am sure that your facility has a progressive discipline policy. Familiarize yourself with it, and use it. Once your subordinates see that you are serious and you mean business, you will begin to gain control of the situation. They will realize that they cannot just ignore you and their work will be done by someone else. I have held staff meetings in which I have openly discussed work performance standards and failure to meet them (although you have to be careful not to call out individuals in an open meeting - that should always be done in private). Giving them a copy of their work performance standards is not an effective way to approach the problem, IMO. They can simply set these aside and ignore them. Going over them verbally in a meeting would be more effective - and by going over them, I don't mean reading them verbatim, but rather presenting them as part of your expectations as a manager.

If your facility administration will not back you, you are in an untenable position. In that event, I would move on.

evolvingrn, BSN, RN · Jan 30, 2013

If you can't set expectations and follow through ...............well then i think your screwed. with blood pressures and such those are basic standards of care. I would set some basic standards of care. we have a 'standard of the month' we review and are held accountable to . (its usually based on a situation that has occurred) we get audits and those audits are posted on the wall (with individual names). its usually targeted standards like fall risk procedures in place, correct blood administration documentation ect...........there are still a few thing you can do but what I'm hearing is you have a disengaged nursing staff. I think you need to form a small leadership team from within your 41 employees that help with dissemination of standards and policies for your floor. (perhaps they can be elected from their peers so that it gives them a voice) when you have your staff engaged in their own evaluation it brings some ownership to the table. but you may not be able to change things over night. its going to be a slow process.

biju27 · Jan 30, 2013

Thank you all for your comments. Today, I brought the subject to DON and they are going to start to inservice the nurses. I also met with the nurses and informed them that I will do a time study on each one of them to find out how they use their time. I am planning to follow each one of them and see how they use their time. As far as the work, I am not complaining, I love to work and will help them as much as I can. However, it is really frustrating when you see nothing is being done as far as charting, and they are always complaining even if they have 10 patients each.

shanshanRN · Jan 30, 2013

I am a new Unit Manager...does anyone have any good professional tips for the job...I have to unify my 3 shifts...it feels as though no one works together...too many chiefs and no Indians! Not to mention some staff that are jealous of the promotion with no well wishes...any suggestions on how to approach my new position and to be an Efficient leader while maintaining a good report with my staff??

evolvingrn, BSN, RN · Jan 30, 2013

Do you get that by 'following them ' to 'see how they use their time' if worded in that manner is going to forever make you the enemy. you need to be their ally not the 'other side' get out there on the floor answering call lights helping with med passes (doing baths ect.........) while your out there you will get every answer you need to know and then you can streamline that info in to a culture change.........but a culture change means a change in roles which may mean 'taking away' some of their traditional responsibilities so they can focus on these new task. For instance knowing that your don't have a full census all the time i would take advantage of that. instead of each nurse taking 10 pts each could they stay at full capacity and one nurse be assigned care plans? or what if they each have 15 pts and one 'serve' as a float so that she takes each load while they each have a couple hours to soley focus on that task without interruption and not falling behind on their other task? ..... do you have a mentor? It sounds like you have some great goals but perhaps could use some help from another unit manager with more experience in helping find a successful way to present it.

Orca, ADN, ASN, RN · Jan 31, 2013

Do you get that by 'following them ' to 'see how they use their time' if worded in that manner is going to forever make you the enemy.

This struck me as well. When you tell them you are going to be monitoring how they utilize their time, that strikes me as micromanagement. I have workled for micromanagers, and it is miserable. I believe that it would be better to say that there are some essential basic tasks that are not being performed, and your expectation is that they will be. Spot check for charting (which you have identified as a main trouble spot), then counsel those employees who are not complying. With charting in particular, I have found it helpful to emphasize that if there is a problem or legal issue over care later on, charting can save you. I was once sued by a patient who made several false allegations. My charting on the night in question refuted everything he said, and the case was quickly dismissed.

Your employees need to believe that you are there as a resource, and that you will support them in your jobs. The tone that you have set early on, first with handing out the work performance standards and then telling them you are watching, paints you as their adversary and someone to be avoided - which is professional death to a manager.

None of this means that you cannot or should not set limits on their behavior and performance, or spell out your basic expectations. There needs to be a healthy balance, however. You are there as their supervisor, not their overseer.