Delegation

[jackson145]

I'm in my last semester of an ASN program and recently we've been hearing so much about delegation. Maybe my hospital is different, but I don't see much opportunity for delegation there.

I work as a Nurse Tech at the local hospital and recently we've had a bunch of in-services about delegating and subordinates. I guess Administration was getting a lot of complaints about certain employees (mostly RN's) telling other employees what they needed to be doing or what they expected them to do.

The new rule now is, only Department Heads have "subordinates". If you don't have the power to hire or fire a particular employee, you DO NOT EVER tell that employee what you want done or what you think they ought to be doing. So far, the policy has really helped with employee moral (the nurses don't care for it, though).

When I graduate from nursing school, I'll probably end up working on the Med/Surg floor at this hospital because it's the only place (other than LTC) within driving distance of my home. From what I understand, as a floor RN, I will not be delegating any duties to anyone.

The Med/Surg floor has nurses and techs. Each is hired with specific job duties expected of them. You do the tasks your employment contract specifies. Sometimes a nurse will notice a patient needs washed or new sheets and they might tell the Tech, "hey I noticed 401B needs ...". Sometimes a Tech will have a patient complain of pain and they might tell the Nurse, "hey 401B is asking for ...". However, I wouldn't consider this delegating.

This is very different than the picture that is painted in NS. I feel like a lot of what is taught in NS isn't relevant to what new grads will be experiencing. Would students be better served with a stronger focus on inter-discipline/department communication?

Has anyone had different experiences with delegating at their places?

[Virgo_RN, BSN, RN]

They teach you about delegation in NS because in many workplaces, you will be delegating specific tasks to unlicensed assistive personnel. Delegation carries with it a certain amount of responsibility, and state Nurse Practice Acts do have rules and guidelines pertaining to delegation. So, it is an important thing to learn about, even if the facility you're working at does not function in this manner.

[Daytonite, BSN, RN]

I had plenty of problems with insubordination when I was a charge nurse in a nursing home as in CNAs who didn't want to do their work. You get into having to document their behavior so the person in authority can discipline them. This has to do with knowing the role and duties assigned to each person. You also have to use some assertiveness techniques, especially if someone gets aggressive with you when you ask for feedback from them. As RNs we are responsible for the care that is being done for the patients under our management. Whether a job duty is on a piece of paper or spoken to someone it is a delegated duty. However, as RNs we are responsible for what a subordinate is doing. If we know that a subordinate is failing to do a task or performing it incorrectly we must intervene in some way. A facility may tell you exactly how they want that accomplished as your hospital does, but it is still doing something about handling problems that come up with delegation--just not the way some would like to handle them.

The general guidelines of delegation are:

• Primary concern is to make sure that the patient is safe
  
• You must delegate tasks to those who you know are capable of performing what you are assigning them to do
  
• You base tasks that you delegate to others on your knowledge of
  
  • the state nurse practice act
    
  • facility policies
    
  • facility job descriptions
    

  [*]Give directions for the task that are clear in order to avoid misunderstandings

  [*]Give a deadline when you expect the task to be completed

  [*]Ask the person to repeat back instructions to verify they have the directions correct if you suspect they do not understand what you are asking them to do

  [*]Follow-up to make sure the task was completed correctly and by the deadline in order to evaluate the performance of the task (this is your supervision function)

  [*]Provide praise when tasks are done well and within deadlines; provide feedback and criticism when necessary

  [*]Assign same tasks to the same individuals if possible

It sounds like your facility may have taken the interpersonal aspects of delegation out of this and put a heavy emphasis on the job descriptions with follow-up to be done by management. Perhaps they felt this made for a better work relationship among the people giving hands on care.

[Cilantrophobe]

Just out of curiosity, who do techs report to? Or even better, who writes their performance reviews?

[Daytonite, BSN, RN]

Ask your manager.

[Cilantrophobe]

manager? what manager? I don't work...

I was just curious if techs have supervisors that are nurses...

Lord, I would be in a world of trouble if I did work and didn't know who my supervisor was, or who wrote my performance reviews...

[inland18mempire]

I've been working as an RN for a while now and I don't really delegate the CNAs. Now that I think of it, I don't really delegate to anyone. The CNAs do their job of ADLs and linens and such, and I do medication and paperwork and phone calls and we all go home at the end of our shifts.

[jackson145]

The Techs have a Department Head just like the RN's, RT's, insurance billers, etc. The Techs have a "Charge Tech" on each shift just like the nurses have a Charge Nurse.

I think my facility went to this particular policy because some employees (mostly nurses, some Docs) were "delegating" to everyone. Housekeeping, dietary, maintenance, registration were all being ordered around by nurses, even though they had their own departments and their own bosses. Some Docs were expecting registration clerks to put orders in for them or get a hold of other Docs for them. It was just chaos & employees were really unhappy. So far, the new system seems to be OK, but I guess only time will tell.

[Daytonite, BSN, RN]

Just out of curiosity, who do techs report to? Or even better, who writes their performance reviews?

When they are hired they are told who their supervisors are and who does their performance review.

[Cilantrophobe]

The Techs have a Department Head just like the RN's, RT's, insurance billers, etc. The Techs have a "Charge Tech" on each shift just like the nurses have a Charge Nurse.

I think my facility went to this particular policy because some employees (mostly nurses, some Docs) were "delegating" to everyone. Housekeeping, dietary, maintenance, registration were all being ordered around by nurses, even though they had their own departments and their own bosses. Some Docs were expecting registration clerks to put orders in for them or get a hold of other Docs for them. It was just chaos & employees were really unhappy. So far, the new system seems to be OK, but I guess only time will tell.

Thank you, this answers my question.

It goes without saying that techs are told who their supervisor is when they are hired, as I believe that is the case for every single person who has ever had a job.