Should nurses still be making beds, delivering trays, giving baths and doing bedpans? Or should these tasks be delegated to nursing assistants?
I'm in nursing school and I can see the value of these duties as opportunities for pt assessment, but the physical demands of these duties wear me out and at times lead the patient to see me as a servant. On days when I've had a nursing assistant to perform these duties I've enjoyed nursing and my workload felt managable.
What do you think? Should nurses duties be redefined?
That's exaclty how I am and it's killing me. I had a hard time delegating to the point now some of the techs I work with expect me to do things such as I+Os all the time. Part of it is I know sometimes stuff is not done and I feel it has to so I just do it. As a result I have a very difficut time getting out of work on time or feel very stressed. Same issue with the unit clerk. She'd miss stuff to write on the Kardex so I'd fill it in and now it's like that all the time. I'm intimidated by her b/c she goes on and on and on about what a good job she does and how bad others do it. It was just little stuff so I'd let it slide. Then it led to I'd scan orders all the time just to make sure pharamcy got the orders quickly. so then when I'd put a chart if I didn't scan it sometimes the clerk wouldn't do it b/c she just expected me too!!! I've created a horrible hole for myself. What I'm getting at is I used to feel guilty delegating which is pathetic.
What has happened is that they are taking advantage of you. They know if they don't do THEIR JOB, you will. You first need to speak to these people when they fail to do their job, such as not recording I & Os or filling in the Kardex. If the behavior continues you need to take it to the next level. The bottom line is that you cannot effectively do your job if you are doing theirs, and that puts patients in danger. As nurses we are actually in a supervisory role when it comes to NAs (or techs) and ward clerks, and as such we may need to deal with them in a manner that a supervisor would, which includes ensuring that they are doing the job and doing it right.
Originally Posted by Jelli_Belli
I think it seems rather selfish that some posters are saying that they do not feel they should have to perform those kinds of duties because it "wears them out". Nursing is work and work, by definition, will "wear you out". That is why someone pays you to go there and do your job. Pawning off parts of the job that some might find more offensive is extremly self centered. Where I work patient care is a team effort. If you have the time then you help the patient, no matter what little initials follow your name. I know that as nurses our jobs will include so much more than basic bedside patient care and that at times nurses are just too busy to complete those tasks without assistance from the techs. This is perfectly understandable and the reason that techs are hired. What I have issue with is the mentality that some people seem to have that upon graduation they become too good to do these simple tasks. Just think about it this way, If you go home wore out at the end of a shift from doing those tasks a few times a shift, think how your techs feel. They do those tasks all shift long and have much higher patient to tech ratios.
Instead of thinking "How can I delegate my work to make my shift easier?" try thinking "How can the work on this unit be divided in a way that benefits all those who work here and keeps the patients the most comfortable?" I gaurantee you a much happier and more unified workplace for everyone.
I'm not seeing where anyone has condoned delegation as the opportunity to make their job easier or pawn off the more offensive aspects of their job. The problem is that as a nurse you cannot do everybody's job, and you also have to prioritize your patient care. The NA/tech's job isn't to pick up the slack from the nurses when they get too busy to provide basic patient care, nor is that the reason they were hired. NAs have a job description, which includes providing basic patient care activities such as bed baths, bedmaking, etc. Although it is considered duties that are delegated, they are still responsible for doing their job and doing it competently. How well they do their job will impact on how well you do your job as a nurse. How effectively a nurse delegates also impacts how well they perform their job.
Team work also involves people doing their jobs to the best of their ability for good of the unit as a whole. It involves everyone on the unit taking pride in doing their jobs well. It's a whole lot more than just helping each other out.
The techs and unit clerk are there to assist you. You help out too but don't feel guilty, intimidated or afraid about delegating when you have too. That's all of our jobs.
As nurses we need to understand, the techs and the ward clerks ARE NOT there to assist you, there ARE THERE to do the job that they were hired for, and to do that job effectively and competently. They weren't hired as a favor for the nurses. You may delegate that they assist you with a specific task, but the act of a person doing their job in and of itself is not assistance. For instance, if I have a patient that needs to be turned and positioned, I may DELEGATE that the NA assist with that task, with the expectation that it will be done and done properly, the NA is not doing me a favor, the NA is doing their job.
I think alot of the personal care given by the RN depends on the type of setting. If I am working ICU with only 2 patients then I have no problem providing all the care to these two patients and my facility has staffed for me to be the one to give total care. However, the new facility I am going to requires me to care for 5 vent patients with 1 CNA and you can bet that I will rethink who is going to be giving the bath. If I am expected to be giving all the meds and weaning patients on vents and doing all dressings and wound care plus tube feedings etc. you can bet the CNA willbe providing most of the personal care..that is how this facility has staffed for and expects to function.
The RN must oversee the CNA to make sure all the patients needs are provided for in a timely manner, that is required of her. If the CNA or tech refuses then this needs reported to their supervisor because they would be failing to perform their duties and should be reflected on their job evaluation.
I have always had a problem delegating to someone something i can do myself. If I really am too busy, i will ask the tech to give my patient a dry bed if I really can't get in there. Quite honestly, i am pretty much a perfectionist and it is hard for me not to do it myself. I often end up re-doing stuff i didn't do myself. I don't consider it "being a servant" if you put your patient on a bedpan or give a bath. That line of thinking is ludicrous. It is part of your job. At the same time, I appreciate the need to delegate when your skills and time are needed elsewhere. Nursing is hard work, period. If you are feeling this way already in nursing school, you might consider work outside the hospital bedside, because you are in for a reality shock. It is very difficult to assimilate all the "tasks" you need to do at the same time trying to critically think through what is going on with your problemed patient, but that is what nursing is.
That's not easy to do when you have one aide and 40 pts on the floor with four to six nurses. Everyone want's the aide at once. Each nurse usually assigned the aide two pts for bath and bed, which still left us with five or six beds and baths plus the meds and txs. Our AVERAGE pt load was eight per nurse....plus admissions. I just can't understand why they WON'T hire more aides. Good aides can make a floor run well. :angryfire
before i became a nurse i was a cna and i remember time after time i woulsd be giving a pt a bath and the nurse would come in and see me giving a bath and say so and so needs the bedpan and i said im busy can't you give it to her do you know what she said no she does do that she did'nt learn that in nursing school well after finishing nursing school that the first thing they teach you basic nursing..now that im a nurse when i have free time i help pass trays give baths and get pts out of bed..but some nurses have attitudes and think there to good to do anythings else then pass meds when it comes to pts..
as an na the nurses and i share most of the bedpan style-cleaning; If there's something I see that they should take a look at I call them. If not,, I'm enough of a healthcare professional to deal with it on my own.
the cnas are are in the front lines..they see things and spend more time with the patients than any other health care worker and they report things that 'don't look right' they may not have trained skills of assessment but they pick up the trays and they know who has not eaten. they know when a patient was perky and happy and now is listless and having trouble focusing on a conversation
do what you can but you are not abandoning a patient when a cna does their job...you have left them in good caring hands
I believe it would depend on the care model for your facility. Normally for a 4:1 ratio the nurse does it all:baths, assessments, medication passing..........etc..........
During nursing school. I do think that bed baths and bed pans should be the students duty to do.
When I was teaching, my first year students would do total care, assessment, vitals, meds, feeding, baths, etc on a few patients. However, as we moved into their last year, I started giving them teams of 5 or 6 patients and their own meds. Plus they had the care plans to do...tiresome paperwork, of course. At that point, I told the floor aides that the 2nd year students wouldn't be doing the aide work except to help, as they were going to be graduating shortly and needed to be performing the RN's primary role. I based it on how the floor was set up where we were doing clinicals. My kids knew that if the aides needed help, they were to help them. I felt assessing and charting on 5-6 medical patients while doing their own meds was a fairly high expectation for students, not to mention the skill opportunities for IV's, NGs, foleys, etc for other patients as they came available.
I've been fortunate in not finding 'RNitis' too often in the areas I've worked. When doing primary care in ICU, I was so thankful for a good tech who could help me, saving me from having to chase someone down who might have a critical patient to try and help me turn and change a bed.
yes, delegate these tasks to nursing assistants. Yes, alert and train your NAs to report any skin changes, bowel or bladder issues....but if you are particularly concerned about a patient, have her call you....she can still give the bath or whatever, an you can take a quick peak at the location of concern. She is your eyes, nose, and ears,but may not know what to look for unless you TRAIN. I am a strong believer in team work. I do what I am trained to do, you do what you are trained to do, and the patient benefits. I appreciate a nurse pulling a bed pan if I am up to my elbows in pooh in another room, for the sake of the comfort of the patient....BUT I do not expect you to do my job.
DusktilDawn
1,119 Posts
What has happened is that they are taking advantage of you. They know if they don't do THEIR JOB, you will. You first need to speak to these people when they fail to do their job, such as not recording I & Os or filling in the Kardex. If the behavior continues you need to take it to the next level. The bottom line is that you cannot effectively do your job if you are doing theirs, and that puts patients in danger. As nurses we are actually in a supervisory role when it comes to NAs (or techs) and ward clerks, and as such we may need to deal with them in a manner that a supervisor would, which includes ensuring that they are doing the job and doing it right.
I'm not seeing where anyone has condoned delegation as the opportunity to make their job easier or pawn off the more offensive aspects of their job. The problem is that as a nurse you cannot do everybody's job, and you also have to prioritize your patient care. The NA/tech's job isn't to pick up the slack from the nurses when they get too busy to provide basic patient care, nor is that the reason they were hired. NAs have a job description, which includes providing basic patient care activities such as bed baths, bedmaking, etc. Although it is considered duties that are delegated, they are still responsible for doing their job and doing it competently. How well they do their job will impact on how well you do your job as a nurse. How effectively a nurse delegates also impacts how well they perform their job.
Team work also involves people doing their jobs to the best of their ability for good of the unit as a whole. It involves everyone on the unit taking pride in doing their jobs well. It's a whole lot more than just helping each other out.
As nurses we need to understand, the techs and the ward clerks ARE NOT there to assist you, there ARE THERE to do the job that they were hired for, and to do that job effectively and competently. They weren't hired as a favor for the nurses. You may delegate that they assist you with a specific task, but the act of a person doing their job in and of itself is not assistance. For instance, if I have a patient that needs to be turned and positioned, I may DELEGATE that the NA assist with that task, with the expectation that it will be done and done properly, the NA is not doing me a favor, the NA is doing their job.