Delegation

[amzyRN]

Delegating to nurse aides is something I find challenging. Some of the aides are very good and I don't have to ask them to do much, but sometimes some aides seem to resent when I ask them to do something. They seem to not understand if i don't have time to empty a bed pan or assist with a bed change. But if I'm giving meds that is my priority (I mean BP meds or things other than stool softeners). Some of them get angry when nurses sit and do charting but don't understand that the charting is important because it's how we do our hand off at my facility. I had one aide get an attitude with me because I questioned them when they disconnected my patient's chest tube suction when taking them to the bathroom. That is common at our facility, but still it's good to check with the nurse before doing that. Any tips on effective delegation? I don't want to ask them to do things that are unreasonable and I also don't want to get bogged down doing things that aren't priorities and miss something important.

[Nurse SMS, MSN, RN]

My tip would be to let the bad attitudes role off your back. You cannot control how they act, only yourself. Let them see you help them once in a while " Hey James, I already got my own vitals - you can skip rooms A-D". Greet them warmly each day and thank them any time they do something for you. If a tech/CNA is a good one, mention you love it when you get to work with them because you notice the patients get good care. Collaborate with them and refer to patients as "ours"..."hey James, our patient in room E had a rough one yesterday Can you let me know if his BP goes above 140 systolic? Thanks!" " James, room B had diarrhea all night. Can you let me know if he has more than four BMs before noon? We may need to see if a Flexiseal would be appropriate."

Make them part of your team, treat them with respect and expect they will do the same. Some have trouble with authority. That isn't your problem. As long as you use care to do as much for yourself as you can and show them how important their role is, you can't let any bad attitudes get to you. That is on them.

[sandyfeet]

When I first started out as an RN, I was really shy and focused on my job. I felt like the techs gave me a hard time too. But as I opened up and got more comfortable in my role, I took more time to get to know the techs and develop relationships with them. I feel like that was key. Once they got to know me as a person and I them, delegation suddenly wasn't as awkward. Remember, they are used to the expectations of an experienced nurse and are learning how to work with you too.

[Meriwhen, ASN, BSN, MSN, RN]

Remember that respect is a two-way street. The fact that you are a RN/LVN doesn't mean that you automatically command their respect, or that you can treat techs disrespectfully and without consequence.

If you want to be respected, you have to respect others...and you may even need be the one making the first move. This doesn't meant that you have to be a pushover or that you can't assert authority when you have to. But you can assert authority professionally and respectfully.

Also, let them see you're willing to get your hands dirty when you have to. Not saying you have to do all of their work for them, but if you can help them, get in there and help them.

[psu_213, BSN, RN]

To piggyback on the last response...

As an RN you have certain duties that only you can do (and techs/aides cannot do), such as assess and pass meds. At those times, certain tasks that the tech can perform must be delegated to the, and, as an RN it is you responsibility to delegate those tasks. If the tech has a bad attitude about having a task delegated to them...well, that is their problem. Just make sure it gets done.

But the thing that makes delegation easiest is if the tech see that you are willing to do the work when you can. If there is a time where you do not have a pressing issue--take the pt off the bedpan, grab a patient food, "clean up" an incontinent pt, etc. We they see you do this, the are more likely to help and less likely to give you attitude. Also remember, tech talk to each other. They will tell the colleagues that you are nurse that helps (or that a nurse does not do anything but play on their iPhone). Be that nurse that the techs want to help.

[dudette10, MSN, RN]

We they see you do this, the are more likely to help and less likely to give you attitude.

I hate this. This is not a rant against you, but just this whole, "Do their jobs once in a while, show them you're not above it, so that they do THEIR job," thing.

I am one of the RNs that the CNAs like to work with. I've heard them tell CNA orientees and patients that. However, I keep my mouth shut about how I hate to work with them. Some of them. The reason they love me? I do work within their job description without complaint because the PATIENTS deserve it...not them.

In the two years I've been an RN, I've got time management down to a science now. Part of the reason is because I've learned to delegate appropriately when I'm busy. I get out on time for months now, but when I realized that delegation is a major part of being able to prioritize my patient care and get out on time, I've been running around like crazy less and started to get some attitude back recently with the "bare minimum" CNAs. I don't like to be crazy at work. I work hard all the time, but crazy hard is just stupid and inefficient and takes me away from advocating for my patients, proper discharge planning, and communicating with the MDs. Plus, it increases the chance for an ERROR...an error that the CNA will never make or have to face the consequences for just because of their job description.

As an RN, I often have multiple tasks that need to be done; I am pulled in many different directions by patients, MDs and ancillary staff. I manage to prioritize them and get them all done. If the bare minimum CNAs have multiple tasks that need to be done, they try to put a halt to any other tasks added to their workload...which then fall on the nurses.

I'm not convinced that "do their job so they do their job" is the way to excellent patient care. It's the way to be taken advantage of by CNAs who couldn't care less about the patient. An RN should always keep in mind that doing the CNAs job is because the PATIENTS need it done. I'm done with trying to coddle the CNAs, and I've put my focus back on the patient where it belongs.

To the OP: If you have a strong work ethic (not all nurses do, and I see that at work too), you will eventually become fed up with the laziness, and delegation will become easier because you are focused on patient care, not being sure the CNAs are able to get in their chit-chat and hiding out time.

[Nurse SMS, MSN, RN]

I have been a nurse about the same amount of time as Dudette but don't really agree with all her points. I don't see CNAs as lazy on the whole. I do see a lot of them working too many hours due to the low pay. I was a tech myself while in nursing school. Their jobs are just as hard as mine. We have 36 beds on our floor and often only have two CNAs. Doing the math, it just isn't possible for them to get everything done on their own. I have found a team approach the best way to promote both good feelings as well as to make the patient top priority. I don't think they are mutually exclusive. I have found when I show I am a member of the team with the techs, they also step up and are a member of the team with me. Who benefits? All of us - the techs, the nurse AND most of all, the patient.

Delegation is absolutely key to surviving as a floor nurse. How delegation is accomplished and the garnering of good feelings between nurse and tech can make all the difference in how that is perceived and carried out.

[dudette10, MSN, RN]

I completely agree in theory. In practice, as you know, it may not work that way if a CNA no longer sees a person in front of them. I have a method of overcoming compassion fatigue during those difficult shifts or a week of them. I take a deep breath and imagine my mother or father in that bed. Works like a charm for me. Some weeks I need to do that more often than others!

Just to clarify, I definitely see a CNAs who will do more when I approach it as a team effort, especially when shift change occurs and the second team comes on. (We work 12s, and they work 8s.) unfortunately, a majority of the first team where I work has taken my willingness to do everything for the patient as a chance to not do as much. I haven't stopped taking care of the patient, but I do delegate more and appropriately because of the reasons I gave above--communicating, advocating, planning are my focus along with reducing the chance of a missed order or a late med where timing is crucial.

On the other hand, and for full disclosure, there are about three nurses I consistently work with who have a lot of free time on their hands, and I am not sure why. I don't have the energy or the interest in finding out why, but I do notice a lot of texting and face booking and vacation planning.

ETA: On the floor I work, the RN ratio is 1:5 and the CNA ratio is 1:8.

[LadyFree28, BSN, LPN, RN]

As a former nurse assistant; one of the things I did when coming on to my shift was get report from the off going assistant; then make sure the nurses I worked with knew I was here, found out important info that they got in report from their assigned patients from off going nurses; ie, if they had complications that she may need an extra eye in that patient if they were to go south. My ration was 1:10, 1:14 or 1:28, depending on shift and/or staffing (usually staffing)

As a LPN and RN, I did the same thing; just in a different role; communicating a plan makes my shifts much better managed, especially if people need wound care or bowel routines, pain meds, or anything acutely planned where it benefits the patient, regardless of role or setting.