Delegation

christvs, DNP, RN, NP · Dec 2, 2007

I had a hard time with delegation too at the beginning. I think you should just tell yourself what you wrote here in your response: that since there are certain things only you as an RN must do (and the CNA cannot do), that while you will be tending to those things, the CNA must do his/her assigned tasks. Realize that it is the CNA's job to assist the nurse, and that even though everyone is busy and everyone has a lot to do, it is still important to delegate to a CNA so you can get to your RN duties in a timely fashion. That being said, do your best to help out your CNA when he/she is up to their ears in work, and you have free time. I have no problem taking VS, emptying Foley's , putting patients on bedpans if I have the time, and the CNAs I work with know that, so now when they see me running around super busy, they chase after me and ask how they can help me out. A little bit of teamwork goes a long way. :) But getting back to your original question, yes, it is tough to delegate at first, when you probably want to just do it yourself so you won't be seen as someone who is telling another person what do to. But as long as you speak to the CNA with respect, and perhaps explain why you cannot get to it, and that there are certain things you alone must take the time to do, you should be fine. :)

Virgo_RN, BSN, RN · Dec 2, 2007

You'll get over it in time. I had a hard time with this at first too, especially since I used to be a CNA and am now delegating to some of the CNAs I used to work with. It's a change in my role and our work relationship. I used to be their peer, and now I'm supervising them. It's getting easier, though. And like the above poster, I do all kinds of things if I have time, like help pass meal trays, empty urinals, assist patients to the bathroom, etc.

I used to get ticked off when a nurse would track me down in another patient's room to ask me to do something for a different patient. I'd think "You were just in there, in the time it took you to track me down, you could have done it yourself!". Now that I am nursing, I understand why nurses do this. The CNA probably is not aware that I have other patients with priority needs that I must get to right away, and even the few minutes it would take me to do something for a patient is a few minutes I don't have. So if I can delegate that task, I need to do so in order to keep my head above water.

I do think there are nurses who abuse this. I worked with a nurse once whose patient was sitting in about a gallon of liquid stool, and already had excoration in her peri area. I needed another person to help me change her. I looked for another CNA, and there was none to be found. Everyone was busy. I looked for another nurse, and there were none to be found. So I asked the nurse whose patient it was if he would help me (he was sitting at the computer in the nurses station) and he asked me if I could find someone else to help. I told him I had tried, and nobody else was available. He repeated that the was really busy and I should try to find someone else. So, I went and changed the woman by myself. It wasn't easy, and I definitely worked up a sweat, but I did it. I knew I was risking a back injury, but I could not in good conscience allow this woman to continue to sit in her stool. Just when I was finishing up, the nurse walks in and says "Oh, I said I would help you in just a minute.". :angryfire

Since this was not the only incident of this type with this particular nurse, I spoke with the charge nurse about him. Of course, I recognized that the nurse wasn't being lazy; he did have a lot on his plate and I could tell. To me, it was a symptom of the nurse (a recent grad) being overwhelmed, and my point to the charge nurse was that this nurse needed some help with organization or time management, because even though it was my job to be delegated to, there is a line, and this nurse was crossing it.

Something I appreciated when I was a CNA was when the nurses included me as part of the team. They would let me know things about what was going on with the patient medically that, even though as a CNA I didn't really need to know in order to do my job, still made me feel like they respected my intelligence and my role as part of the team.

Anyway, I try to keep all of this in mind when I delegate. If it's quicker and easier to just do something myself, I will. If I am working my tail off and still sinking, I delegate as much as I can possibly delegate, but I avoid putting my CNAs in the same position I was put in before. I will take the time to help with a two person transfer or bed change, because that patient is my patient too, and I have a responsibility to them. I'll even assist CNAs with another nurse's patients if I am not busy and I can tell the other nurse is.

On the other hand, there is a CNA on our unit who insists that the nurses should help pass meal trays. She will even do an all-call on the overhead system that the trays have arrived, and help is needed in passing them. I ignore it. I have meds to pass at dinner time, I have insulin that needs to be given at a specific time in relation to meals, and I have assessments to finish up and chart; and of course, the ever present fires to put out. Passing meal trays is the CNA's job, not mine, and I will help do so if I have time. But I will not be pressured into getting behind on my work in order to pass meal trays. This CNA demonstrates a total, complete, and utter lack of understanding of what the nurses are doing, and she is not the only one.