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Discussion

Delegation Frustration

I'm a new grad one month into my first job on a busy post-surgical floor. I've been at this organization for several months (in other roles) so I knew everyone before starting as an RN. Because we're working with post op patients, there's a lot of q4h things needed (per policy). Now, I was a CNA before going to nursing school, and I remember being taken to task for challenging a nurse (I was written up twice - mostly because I was a rebellious teenager at the time, but I learned my lesson and adjusted my attitude). The CNAs in this facility seem to push back hard on the nurses - not just me, but most of the nurses - when I've asked people (politely) to do a vital or a blood glucose I've been told "go do it yourself" and "I'm too busy" (this person had been sitting, texting for two hours). At the beginning of my shift I write up a very clear list of what each patient needs, give them report and prioritize needs, and at the end of the day, I'm lucky to get a quarter of my vitals, chem sticks, bed changes, toileting, turn and positions - ugh. Yep. Guess who has to do the rest. I've tried everything from being polite to firm reminders, and nothing changes.

Supervising a CNA is simply one more task for me and another layer of accountability, which feels difficult given that I'm still trying to learn the ropes of this new, challenging job. Linens are never changed, the environment is a dirty, patient complain and I honestly don't have time to do my job and theirs--I am stretched very thin. it's not just frustrating for me - it's crummy for my patients. I know there are great NAs out there (I've worked with them at previous jobs), but the culture of this floor definitely doesn't foster that and the manager doesn't care--morale is very obviously bad. I haven't gotten "eaten" by the older nurses (quite the contrary, they've been very helpful), but every time I have a review and they ask me about my delegation skills, I honestly don't know what to say. I'm getting "eaten" by the NAs, for certain.

Before you mention switching, I have to have at least six months of employment in my current position, so I'm trying to stick it out since the job market is tough and I'm better off trying to switch to another floor than find a whole new job.

Sorry, I know this is just typical new grad venting but I needed to get it off my chest and didn't want to say anything to my coworkers, potentially creating an even more hostile, low morale situation.

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    • Featured Replies

    Have you spoken to your unit manager? That would be where I would start. If the unit manager agrees that the CNA's should be doing the tasks they are asked maybe they would be willing to bring it up to everyone in the department as to not single anyone out. As a new person you don't want to be walked all over but you also don't want to be hated.

    My first nursing job was in a nursing home. The CNA's did not want to do anything for me at first. Over a month or so I showed them I was a team player and no work was above me if I had time. When they needed help with a boost I would offer to help, when I was able to multitask and get vitals or do a task they usually did I would and I would let them know I took care of it. I let them know we are a team regardless of job title. It helped and changed things significantly.

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    • Experts

    Since you have been clear in communicating your expectations, it is time to take action in the form of verbal warnings, write ups, and pushing up the chain. Even if you are aware that your supervisors will take no action, you need to make written counseling sessions and keep copies so that when it is time for your own evaluation or when there is an explosion of the volcano, you can prove that you have been doing your job all along. You can't help it if your supervisors do nothing, and you can't go backwards to create a paper trail. But you need to create and maintain a paper trail as much to protect yourself as to bring about any meaningful change in behavior. Good luck.

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    • Author

    Here's the kicker: I don't have the authority to write them up and my manager is very good friends with the senior CNA and backs them up, so I feel like my hands are tied. I'm also worried about being labeled "troublesome" so early in my tenure there. I'm not asking them to do anything I wouldn't do or haven't done in the past (I even worked along side many of them during nursing school)--right now there's a contract negotiation issue that has only made things worse. I was told by the manager that nurses are responsible for things that are not done, and making sure they do their job is part of my job - but I'm not sure how I'm supposed to enforce that if they don't give me any real power. I wasn't sure if this was the norm or just a fluke of this particular facility.

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    Would it help to maybe approach them on some of the tasks in a different way? Maybe ask them if they can lend you a hand to clean up a patient or turn a patient? Maybe they would see that you're willing to work with them and they'd lose the chip on their shoulder?

    I'm new to nursing, too, but I've found that some CNA's feel taken advantage of. If you can show them that you value their help, they might be more likely to give it.

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    Here's the kicker: I don't have the authority to write them up and my manager is very good friends with the senior CNA and backs them up, so I feel like my hands are tied. I'm also worried about being labeled "troublesome" so early in my tenure there. I'm not asking them to do anything I wouldn't do or haven't done in the past (I even worked along side many of them during nursing school)--right now there's a contract negotiation issue that has only made things worse. I was told by the manager that nurses are responsible for things that are not done, and making sure they do their job is part of my job - but I'm not sure how I'm supposed to enforce that if they don't give me any real power. I wasn't sure if this was the norm or just a fluke of this particular facility.

    No, it's not the norm, but I think the fact that you started as an RN on the same floor you on worked as a CNA is adding to your troubles. In general, I advise nursing students against this.

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    I used to be a PCT and if u honestly do everything you said you did I wld have loved to be paired up with you. Seems like your a team player and dont think your above anything. The thing about CNA or PCT is they are usually over worked, underpaid and quite frankly jealous. In their mind a PCT and a RN are doing the same thing as far as patient care goes. And RN's get paid more and way more recognition.

    Usually when you have a CNA like that they have it in there minds that all nurses are lazy...especially new grads. They think new grads depend on them for everything. Which in some cases are true.

    As a pct I had my fair share of nurses who thought they were too good to clean a patient and had me do everything and they just passed meds and I have had nurses that rather did everything themselves and only asked for me when they truly needed me. I recently quit my pct job because I was used and abused on my unit. I had 10 patients and was split between two nurses on a med/surg floor. It made 2nd guess nursing but turns out it was just a horrible floor.

    My advice to you is to network. Does your unit have a floating policy? If so use it and pay attention on how there unit works and get to know there techs/cna. Or if u see a nurse on your way to the parking lot ask them how there unit is and abt there teamwork. Goodluck!

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