Delegation in an LTC setting

by WorkinMama WorkinMama (New) New

So I was wondering if anyone else out there has issues with delegation in LTC setting. I need advice on how to work with some CENAs who don't follow through on basic delegation (vitals or can you get water for so and so while I'm in the middle of passing meds). I know I could write everyone up technically but some of this is so gray for me. Granted I am a new to this type of work and I'm learning a lot daily. And yes I do appreciate and respect CENA's for all they do. I appreciate all the direct care they provide and need them to communicate with me. However that comes back to my issue I have CENAs getting attitude with me and I can't put my finger on it but yeah you probably know what I mean.



30 Posts

Unfortunately, sometimes you have to write up. If you are new, perhaps they are testing you to see how much they can get away with...



Specializes in LTC. Has 1 years experience. 63 Posts

Sadly, I know all to well what you mean by attitude. I'm newer to LTC, a little over a year working at my facility, and even newer to working my position on midnights. Where I work, you're the only nurse on the floor and you have 4 aids to assist you. There's a total of 4 floors to the facility, so there's other nurses in the building. But, you are in charge of your floor for the most part.

I float to the other floors, so I have a whole array of different personalities when it comes to midnight aids. For the most part, we all help each other out. I answer call lights and get things when I can, they help me with vitals when I need. But, I have had experience with some aids who have worked there for many years and are use to their "routine" of not helping and doing whatever they can to avoid work. I've gotten flat out "NO" when asking to help with vitals! Unbelievable, I know!

I don't like going the route of writing people up, and haven't had to get to that point yet luckily. When faced with those attitudes, I've either tried to deal with it myself (calmly talking to the aid to see what's going on with them), or I've involved the Resident Care Coordinator from the floor in the morning. Usually it resolves itself, sometimes management has had to take a step in to correct the situation. And, sometimes (just recently) their attitude has come across to a resident and they've been suspended for resident complaints. Another nurse in my facility has advised me in tough situations to keep a log with dates/times of when you asked the CENA to do something and they didn't do it. And, in the end, present that to management so it is known the issues you've had and the correct measures you've attempted. I haven't started one yet, and I hope I don't have to.

Good luck to you!



Specializes in Wound Care, LTC, Sub-Acute, Vents. Has 5 years experience. 1,547 Posts

they are testing you because you are the new kid in the block. do you work with other nurses on the floor? you may want to ask the seasoned nurses on the floor how to deal with some of the lazy cnas.

i approach each cnas differently when delegating tasks. some of them i ask to do the task, some of them i tell. there is a difference. with the good cnas, i ask like this "when you get a chance, can you please get mr. smith's rectal temp?" and they will give it to me in a timely manner. the lazy cnas, i tell them like this " please i need mr. smith's rectal temp by 5pm, ok?" sometimes the lazy cna still would not do it by 5pm and give me the attitude when i ask for it. so i involve my supervisor and the supervisor tells the lazy cna to do it and i get the rectal temp like in 5 minutes.

the lazy cna knows how to play the game so you must learn how to play it as well. i would rather report the lazy cna to the supervisor than to write them up (sometimes you have to write them up though). then the next morning i report the cna again to my unit manager. i work 3-11 shift so i have a supervisor on that shift and unit manager is there 9am -5pm. i double report the lazy cna. the lazy cna get talked to twice (by supervisor and unit manager) so at least they know i won't tolerate their insubordination (i have a very supportive unit manager so i am lucky). after i do this a couple of times, the lazy cna do what i delegate to them in a timely manner.

of course i do not report everything and i give the lazy cna a chance. i wait until it is a trend and not just due to having a bad day or something. sometimes i just do myself the tasks i delegated to save myself some aggravation. pick your battle wisely because sometimes the cnas gang up on you.

you also have to show your cnas that you are a hard worker and not just delegating everything. i empty urinals, bring patients to the toilet, get patients water/cookies/blankets/ice/diaper/pull-up/etc..but when i am extremely busy especially when i have new admissions or readmission, i delegate all these to the cnas.

just learn and know the culture of your unit and it will get better as time passes by.

good luck!

Edited by agldragonRN

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 29 years experience. 1,162 Posts

I've been out of LTC for 13 years, but it seems like some things never change. Honestly without administration behind you all the write-ups in the world won't help. The CNA job is too hard and too under-paid; many times admin. would rather replace a good nurse than a lazy CNA. That's why some are never disciplined.



932 Posts

I've only ever written up one CNA in my life and that was because another (new) nurse had come in and immediately started writing people up for no particular reason, so I was asked to put my own assessment in writing. I wasn't happy about it, I thought she was overreacting to a performance issue that could have been better handled with a conversation or the intervention of the charge nurse and I made sure to mention that.

Try to talk these things through and involve your immediate supervisors. You start off writing people up before you have put in the floor time to really know them, you are going to make a lot of enemies. Delegation is hard. Supervising other people is hard. It's a learning process so give yourself time to learn it and give the other staff time to learn how you like things done. Don't just go from zero to full on monster manager before making that effort.


DixieRedHead, ASN, RN

Specializes in ED/ICU/TELEMETRY/LTC. Has 20 years experience. 638 Posts

You need to talk to the nursing management. A policy should be in place so that vital signs are done within 30 minutes of a shift starting. If stat vitals are needed, you can get them or ask someone to get them for you.

Sometimes people don't get that vital signs are called vital signs because they are VITAL.

You need to stop passing the buck to the unit manager. If they are lazy, they are lazy, don't tolerate it.