Delegation

Quietstorm1234 · Jun 15, 2007

I understand how you feel. I think we will get better with delegating once we get more experience. If I do what needs to be done myself then I know that it got done and that it was done right.But this can be so tiring.

Daytonite, BSN, RN · Jun 16, 2007

i'm thinking that you might be confusing delegation with insubordination. when you give someone you supervise an instruction and they flat out refuse to do it, that is insubordination. that's a performance and behavioral issue. have you spoken to your supervisor and asked for advice on how to handle this? i'm not talking about the charge nurse, i'm referring to the person who does your performance evaluation.

you also need to be smart about doing your nursing job. you need to stop feeling sorry for the techs and stop doing their work and covering for them when they disappear for hours at a time while you are laboring to get your work done. report their disappearance to the charge nurse, manager or the shift supervisor if you are on an off shift. do you think they'd be off fooling around if they were worried about you and the patients? they can't do your work. and, if they are not getting theirs done, as i mentioned above, it needs to be reported to the charge nurse, manager or shift supervisor and it needs to be documented. one of the realities that a person in a leadership position is able to see is that not everyone is a good employee. do not assume that just because you have always been a good employee that others are also.

i really encourage you to have a talk with your boss and discuss these problems. ask the boss what he/she wants you to do in response to this behavior by these techs so you have clear direction on how to handle it. i think that you are going to have to get assertive with some of these techs and stand your ground with them. right now, they are being very disrespectful to you. your response, however, can't be to go out of your way to do their work that they are dumping on you. that only feeds their disrespect toward you. they're sneering at you behind your back. also, these techs are cheating your facility of the time and work they are being paid wages to perform. as an rn, which is a leadership position, you have an obligation to see that this information gets passed on up the chain of command.

as for delegation, there are principals of delegation that should be followed and i'm listing links to them for you. you might also want to review the principals of assertiveness.

http://nclextestprep.com/delegation.html - points to ponder when considering delegation and nursing management of personnel.
http://www.leadershipdevelopmenttraininghowto.com/elements.htm - the elements of delegation
http://www.ehow.com/how_3816_delegate-responsibility.html - how to delegate responsibility
http://www.see.ed.ac.uk/~gerard/meng/me96/documents/aspects/delegate.html? - delegation. everything you need to know about delegation presented concisely.
http://changingminds.org/techniques/assertiveness/assertiveness.htm - assertiveness
http://www.dlsweb.rmit.edu.au/toolbox/fmi/content/tutorial/assert/assert00.htm - this is a really nice online assertiveness tutorial from australia. click on the links to proceed through the tutorial. includes sound clips of examples.

Rizpah · Jun 16, 2007

Daytonite - wow, thank you for posting those links. I'm currently having problems with a "peer" with less seniority and I was told I have to stand up to her and assert myself. The links you have posted on assertiveness are awesome! Maybe I'll learn something!

Dolce, RN · Jun 16, 2007

When I graduated from nursing school I thought I was going to have a big problem with delegation because of my age. However, this has never been an issue for me. I start the shift by giving report to the CNA--giving them both information about the patient and the tasks that need completed during the day. Even though they already may know, I mention the people that need BGs, bladder scans, etc. By having good communication at the beginning of the shift there is no confusion about "he said/she said" later. The expectations have been clearly stated. Then, check up on them throughout the shift to ask if they need help, to make sure that important information is being communicated between each other and to make sure that tasks are being accomplished. Don't be afraid to say in a very nice way, "Have you gotten the BG for so-and-so yet?" Being a team player is important. However, CNAs cannot do your work so you should not be expected to do their work. For the ones who argue about assignments and delegation I just let them know what needs done and walk away. Yes, sometimes they get mad, but a simple "thank you" when they have completed the task is appropriate. Eventually they should learn to respect you if you set limits.

brax881 · Jun 16, 2007

I feel your frustration:angryfire I transferred to a new unit where the techs are completely useless. I honestly feel like they walk around with the automatic blood pressure machines just to look busy, then they are always disappearing. I have only been on this new unit for 4 weeks and I have noticed how atrocious their work ethics are. The problem is there is not enough supervision, and Techs don't respect nurses as their superiors. Also the techs have no accountability, they feel if is not done it will fall back on the nurse.

I just did a recent thread voicing my annoyance with the techs and ask for the input of other nurses on how their hospital handled tech assignments. I received 1 reply, it stated "Kinda been there done that, found another area and am perfectly happy. Maybe you should try another area. Good luck".

Sad that nurses are leaving floor nursing where are are need the most, just because of Tech issues.

Idon'tcodgerdodge · Jun 16, 2007

I have the same problem at my work and I'm getting really fed up.. I am a fairly new nurse and only 22 years old. The techs I work with have four of my patients and four of another nurses patients, but I usually have 6 patients, so I'm taking two by myself. Anyways, the techs are older than me and have been doing this a long time, so they give off the impression that what they say goes. I've been less tolerant lately. I'll ask him/her to please get an isolation cart for a patient and 3 hours later, it's still not done. That's rediculous! Actually, at the end of the shift, she was sitting at the nurses station when I asked her again about the isolation cart, she responded with "the next shift can get it". LOL How lazy! I think they think I stand around all day and only pass meds, but they don't realize how much nurses are responsible for. Another thing that bothers me...I get a page that my post op is in the room..and so does my tech. But undoubtedly, the tech never shows up to help get them settled and start their vitals. So I wind up doing everything and their excuse, "I was busy and couldn't get there". :angryfire (Do they think I wasn't?? But I dropped what I was doing to get there)

Daytonite, BSN, RN · Jun 16, 2007

all you younguns', listen to me. your problem is partially one of delegation, partially ineffective interpersonal communication, and partially insubordination. when you give an employee an instruction you are delegating. part of delegation involves supervision, following up, getting and giving feed back on the task you delegated. you have to perform that supervision part of delegation too. speaking directly to a belligerent or contentious tech, cna or whatever you call your assistive staff, requires you to have some knowledge of and use some assertive techniques. know what their job description is if they want to play that game with you. in some cases, it's almost like dealing with spoiled children who are masters at manipulation. the way to beat them at this game is to know the rules better than them. we're educated people, folks. put your noodle to work on this problem. it is fixable. when you see the results of the efforts you put into researching and solving this problem, you will be very proud of yourself and begin to feel like the rn you are.

in my early years of working with some really obnoxious cnas in nursing homes i took a few seminars in dealing with difficult employees. every seminar stressed assertive techniques. i've listed some books and other resources that i have that will help you when an insubordination problem comes up, but like any other nursing skill they take practice to learn. i used to reheorifice what i was going to say to one of these difficult people before i even said it to them. your heart will be pounding and sweat may even roll down your back. they won't know that. the important thing is the words you say and tone in which you say them. it establishes your authority. you don't explain yourself, you don't have to, you have the authority to delegate the task to them and it's part of your job. remember the first foley or the first iv you inserted? think about how you do those skills now. well, speaking to difficult people is the same thing. it's a skill that takes some practice. you guys are going to get plenty of it, i can tell. i don't envy you and i do know what you are experiencing because i had to go through this too.

managing difficult people: a survival guide for handing any employee by marilyn pincus
working with difficult people by muriel solomon
games people play: the basic handbook of transactional analysis by eric berne, m.d. (this little gem is a classic is required reading for most programs in counseling. it defines the various manipulative games people play, and we all play them, to get control over other people.)
http://changingminds.org/techniques/assertiveness/assertiveness.htm - assertiveness
http://www.dlsweb.rmit.edu.au/toolbox/fmi/content/tutorial/assert/assert00.htm - this is a really nice online assertiveness tutorial from australia. click on the links to proceed through the tutorial. includes sound clips of examples.