I'm in my last semester, and I have a few weeks to go. Specifically, I have a more shifts managing a 6 patient load. So far, I've completed 14 days. I work on a Neuro Med-Surg floor.
My question lies in the delegation portion of the job. The team I generally work on includes me, my preceptor (RN), and an LPN. For the most part, my preceptor has been stepping back and letting me manage my patients. She of course is always right there to answer questions, provide support, or in some cases demonstrate how to handle some of the more difficult situations that arise that they DON'T teach about in lecture.
I've found that oftentimes, most LPNs (that I've worked with) can't simply be expected to be consistent workers. One LPN in particular will more or less leave my 6 patients be as far as washing up / bed changes / etc. I realize that the majority of the nursing students they see on that floor are first level students with one patient who are required to do all that stuff. I think that is what they are used to doing. I've even been writing on the LPN's worksheets to complete the bedbaths/VS/etc and it still isn't getting done half the time (that is what my preceptor normally does). When my preceptor writes things, I've found that the LPNs will reasonably complete the work she gives them. I've even had the float walking around taking everyone else's fingersticks, then leave the fingersticker on my medcart so I can do my patients
Of course, it then falls on me to make sure it gets done, and sets me back another 10 minutes depending on how many FSBs I need that day.
It is literally impossible for me to get my meds done/assessments/charting/bed baths/etc on 6 patients in the time period I am allotted. On top of that I'm keeping up on new orders (which happen constantly), and dealing with families. I can't even get into the suremed on my own, so if I need something out of there I have to grab my preceptor and have her open it up for me (which happens roughly about a million times a day.) Specifically, I've found how easy it is to get behind. If anything unusual happens or is ordered early in the morning my entire day gets shot in the foot. I know I can't do this all myself, and I shouldn't have to, but I feel like I am not getting a whole lot of help from the support staff.
I've brought this up with the LPN in question, and have even flat out told her, "I'm not going to be giving them bedbaths, or taking their vital signs, you need to do it! When I'm done with the charting I will help, but I need your help to get this done." It didn't really help very much.
Obviously, in the end I am responsible for the care these patients recieve, and I am afraid that sometimes it is not as good as I would like it to be. Not that anyone on the unit or my team is ever standing around, but I would like to be able to delegate more efficiently. Obviously my status as a student nurse doesn't help, because even the LPNs won't listen to me half the time.
In the past several clinical days I've had, I've missed so many breaks to complete work it is ridiculous. I've also had truncated lunches and all that nonsense. I realize that sometimes this will occur in my career, and I'm not complaining. However, I would like to be able to delegate things successfully enough where I can step back from my patients for 30 minutes to grab a bite to eat, and not have to worry about whether scheduled meds are going to be completed.
I certainly admit that I do have a problem being assertive. I think I am getting better about it, but I can certainly see where not being assertive enough will lead me in the future (especially if I have to manage 10 patients with only me and an LPN!).
Can anyone make any suggestions on how I can improve my practice in this respect? I've been reading over the management books, and there are lots of suggestions in there, but I was wondering what works for you to make sure people are doing their jobs? How does it work in your institution? Have you developed successful working relationships with the various LPNs/CNAs you work with? Or do you always have to tell them what to do all the time?
Mar 29, '07
Quote from midcom
all i can say is that if you truly believe that "most lpns (that i've worked with) can't simply be expected to be consistent workers" and you act that way towards them, then you deserve all you are getting from them. good luck with your 6 patients. you're going to need it.
after 14 days of clinicals, working with this particular group of people, and having them consistently not do the things that they would normally do for any rn they work with, i feel justified in saying that. and no, i do not act that way. i'm a very easygoing person, not rude or snippy in the least bit, and am very respectful to everyone in clinicals. maybe i'm even too polite. but thanks for the advice!
Quote from txspadequeen921
i realize that you are new to this but 2 nurses should be able to handle 6 patients....to get more respect from the lvn you are working with... realize that she is a licensed nurse and don't order the people you work with around. you should get together and work on a plan for the day and them work together as a team....
you are right, and that is why i don't understand why i'm not getting breaks etc (2 nurses...my preceptor will step in when necessary but for the most part i just do my thing).
and good god no i don't order anyone around. i am the anti-ordering people around, which is why i asked for advice on being more assertive. maybe you missed the part when i asked
the lpn for help with the bedbaths (not ordered) her, and she still didn't really help me. i will definitely try more open and better communication in the morning and working out a plan for the day.
Last edit by november17 on Mar 29, '07
Mar 30, '07
Hang in there. When we were precepting during our senior year, they talked a lot in our leadership class about delegation...how we should be practicing this in the clinical setting. The general consensus amongst us was, "Yeah, right". Being a student is NOT conducive to successful delegation, for the most part. The goal, in my opinion, is to get PRACTICE and not worry so much about how effective you are.
Yes, it sure as heck makes life more difficult as a student if team members aren't willing to pitch in. I would be taking that up with your preceptor, NOT
the LPNs you are working with. She would be the one to give you advice on handling the situation, knowing her co-workers.
Be prepared to have similar issues when you start your new nursing job, depending on who you are working with. Some of your team members will need to get to know and respect you before they jump in and help you out without you having to hunt them down and ask. Just be professional, tactful, and do things in turn to help THEM out when you can.... I have found that to be most effective in earning respect and encouraging team work.
Last edit by LeesieBug on Mar 30, '07