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?
In my last semester of clinicals, with the overview of our preceptors, we RN students were to take over the team...we would delegate the assignments of vs, am care, feeding if necessary, blood sugar and insulin coverage, meds, admits from surgery, dressing changes, new orders, discharges, etc. The idea was for the student nurse to get some practice of how to run a team, with the protection of the preceptor. I had my preceptor, me and an LPN, and usually 8-9 pts. on a surgical floor. All 3 of us would take report, then I was to assign my preceptor & LPN and myself to assignments. We would regroup through out the day.
I had my preceptor as a resource. All of us did total care for our pts, with me as the "charge" of my team making sure all was done timely, etc. It was difficult for me to delegate to others, however, I would always ask for their input during assignments. We were to assist each other when necessary...and stay communicatiing through out the shift. When I made assignments, I would give the rationale for why I was assigning pts. a, b and c to the LPN, d,e,f to me etc, to let my preceptor and LPN know where I was coming from. It is a learning process, and sometimes I would change an assign. after their imput.
I loved my LPNs during clinicals. They role-modelled to me team work, and that we were there for the patient. I wish delegation were as "simple" now...
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.
psalm, RN
1,263 Posts
In my last semester of clinicals, with the overview of our preceptors, we RN students were to take over the team...we would delegate the assignments of vs, am care, feeding if necessary, blood sugar and insulin coverage, meds, admits from surgery, dressing changes, new orders, discharges, etc. The idea was for the student nurse to get some practice of how to run a team, with the protection of the preceptor. I had my preceptor, me and an LPN, and usually 8-9 pts. on a surgical floor. All 3 of us would take report, then I was to assign my preceptor & LPN and myself to assignments. We would regroup through out the day.
I had my preceptor as a resource. All of us did total care for our pts, with me as the "charge" of my team making sure all was done timely, etc. It was difficult for me to delegate to others, however, I would always ask for their input during assignments. We were to assist each other when necessary...and stay communicatiing through out the shift. When I made assignments, I would give the rationale for why I was assigning pts. a, b and c to the LPN, d,e,f to me etc, to let my preceptor and LPN know where I was coming from. It is a learning process, and sometimes I would change an assign. after their imput.
I loved my LPNs during clinicals. They role-modelled to me team work, and that we were there for the patient. I wish delegation were as "simple" now...