Delegation Woes

FutureCRNP · Oct 18, 2015

The most experience I have CNA wise is mostly from long term care rotation in school and the other clinical rotations we have had. I'm certainly not as quick as some of the CNA's I've seen.

I do see both sides of the coin now. I've never been a manager of any sort, so I think the delegation aspect scares me a bit if you will. I'm hoping to be the best and most safe nurse that I can be without any med errors/mistakes.

I think that it's just going to take time and experience for some of my skills such as delegation to become second nature and feel comfortable.

Alisonisayoshi, LVN · Oct 18, 2015

I plan on being a nurse who helps as much as possible, isn't afraid to take someone to the restroom, give a bath, feed, etc...but I don't want to get taken advantage of..

I'm a newer LVN in LTC/Rehab as well. I wanted to be that nurse too. I'm going to burst that bubble right now for you. You just can't. No matter how much you want to, you can't. Unless you are in some amazing facility, you most likely just can't. Sorry.

I run one med cart some nights, two others. On nights I run two, I have up to 40 residents. 2 g-tubes on that run, mutiple crushes, lots of residents who are very very slow pill takers, tons of Medicare charting, 9 or 10 diabetics, still more residents on breathing treatments, CPAPS to go on before bed, it's an endless list of tasks I've got to do that the CNA cannot do for me. In order for me to do it all, they must get the work I delegate to them done.

That doesn't mean I ignore requests from residents, or let people sit soiled, I don't. I don't, however, do delegated tasks. I have medications to give, families to speak to, doctors to call, changes in condition to assess. If I fed and bathed people, how would any of that happen? Would I be providing quality care if I didn't delegate every last thing I could? No I wouldn't.

The CNA'S I work with respect me. They work well with me, and they work hard for me. They do so because I made an effort with them, to learn their routines so I wasn't interrupting them unless I had to, to thank them when they did extra for me, to praise them when they were having a rough night, I listen to them about the residents and I never brush them off, and I take the seasoned ones advice on simple CNA stuff (it goes a long way to respect that they have a level of knowledge gained from experience, like how to get a reluctant resident to open their mouth to take applesauce and pills, for instance).

FutureCRNP · Oct 18, 2015

Too awesome for words! :snurse: I hope I get to work with someone that awesome that would look out for me like that!

NYTramaRN, RN · Oct 19, 2015

I plan on being a nurse who helps as much as possible, isn't afraid to take someone to the restroom, give a bath, feed, etc...but I don't want to get taken advantage of..

Well as long as your responsibilities are in order that's fine. I've never sent anyone to do a task I haven't done myself. The important thing to remember is that; you are responsible for your work, and to see that they have done their work in a satisfactory manner. I imagine your ideal and the the reality of the work at hand will sink in soon enough. They are getting paid to perform within their scope, you taking on extra work and stressing yourself is not going to make you a happy camper in the long run.

ambr46 · Oct 19, 2015

You really have to help them out when you can. When you need their help just ask in a matter of fact way. Patient so and so needs a linen change. They can be your greatest asset but there is a little give and take. If they know they can rely on you they will be there when you need them.

FutureCRNP · Oct 19, 2015

I'm greatful for all of the opinions and advice!I'm taking note of all the nurses that have more experience than me and listening carefully.

I guess I'm just so excited about being a nurse that I want to make a big difference in the culture of "Nurses" vs. "CNA's". I've just heard that there can be such a big divide at times and I'm so ready to show that I can be part of the team. I'm so proud and excited to be a nurse that I even have a whole weeks worth of colorful Disney cartoon scrubs neatly pressed and hanging up in my closes with matching shoes and socks. =)

However, on the same note, I do understand that on a LTC floor, nurses can and often do work short so I need to be sure not to lack in my own work like med passes, tube feelings, wound care etc so that I don't experience burnout.

I just LOVE nursing SO much that I went immediately into my schools bridge program for LPN to RN a month after graduation from the LPN program and will have my RN DEC 2016.

DowntheRiver · Oct 19, 2015

When I'm delegating to the MAs I always say something like "You go triage the next patient and I will take care of this wound care." Basically, you don't want to look lazy but it is letting the person know that you are doing something and expect them to do something.

Whenever somebody makes an error, I always try to start on a positive note by complimenting them on something and then tell them what needs to be corrected.

Glycerine82, LPN · Oct 19, 2015

Don't make them feel like you're above them, make them feel like you're a team. Ask them but tell them at the same time. "When you get a chance, Mr. xyz is asking to use the restroom" If you CAN do it, do it, don't delegate for convenience and they'll recognize that and bend over backwards to help you.

When you see them doing something right or well, tell them! Don't only offer criticism, but praise as well. Most seasoned aides know what their jobs are, but if you do need to delegate just be kind about it and not bossy. :)

FutureCRNP · Oct 19, 2015

Sounds like the majority of the CNA's, at least on here are reasonable to work with. :yes:

Postpartum RN · Oct 19, 2015

Although this viewpoint is not politically correct, I am in total agreement with it.
Many of the CNAs will resent the nurse whether or not you bust your ass answering call lights, feeding, toileting, showering, and making beds. You can help the CNAs with their duties, but they cannot help you with licensed nursing duties (read: Medicare charting, medication administration, incident reports, et al.).
The nurses who bend over backwards to 'help' are often the first ones to burn out and be taken advantage of. Sure, the CNAs might comment that "Jane is a good nurse," but this doesn't automatically confer respect upon Jane.
This is why I focus on licensed nursing tasks first and foremost. State surveyors and nurse managers care first and foremost about your paperwork and documentation. They don't give a rat's behind that you 'helped' the CNAs. They couldn't care less if every resident's pillows are fluffed. It is all about priorities.

I agree with the both of you. And the reason I agree is because I have learned this to be true through experience.

When I started as a new nurse at a snf, I was very "nice" and always said please and thank you and did that with a smile (I still do but my tone of voice is different and I use a bit more authority). I think I was too nice and reeking of insecurity as an RN. I got taken advantage of and talked back to and even yelled at by CNA's, and I didn't do anything about it because I couldn't stand my ground. They saw that I could be taken advantage of and they wasted no time in doing that. I have really evolved as a nurse and as a person with years of experience on the job. If I was doing it now, I would have done differently. I wanted to be their "buddy" thinking they would help me more if I was. I was wrong for the most part. The "bad" or "lazy" CNA's who see this in you will take advantage of you for sure, if you let them.

I suggest treating them professionally and with respect of course, being courteous. But not too nice or sweet. Also when delegating tasks or directing them to a pt in need, do not ask in a tone of voice or manner as if you are asking them a favor. Ask politely but make it clear that you are expecting them to do this. Also, if they disregard you in what you asked them to do, make sure you follow up with and hold them accountable the first time you notice it; otherwise they will expect you to ignore it every time and will walk all over you. Trust me.

As others have stated, don't be overly helpful because then the CNA's will think "I can get away with not doing this because that nurse always will do it herself anyway".

Heres a little random tip for you..when passing meds..if you have a pt with thickened liquids, just use the water in their pitcher to give them their meds..a whole lot faster than thickening up a cup of water on your own to the correct consistency. Also, this way you can make sure they have fresh water. One time I poured water into a cup from a pts pitcher and noticed something floating in it. I opened the pitcher and low and behold it was growing MOLD inside!! I was livid and wrote up a lengthy report to the DON. Every shift the CNA's are supposed to provide fresh water to the residents, I wonder how long that pitcher was standing there? AND, had they actually offered the pt some water they would have noticed it's bad water. Double whammy, not giving the pt any fluids in between meals and not getting her a fresh pitcher of water for obviously a long time.

Hope these tips help a bit.

FutureCRNP · Oct 19, 2015

Postpartum,RN- thank you.

I feel like my issue may be insecurity because I'm such a new nurse. I need to learn balence

TheCommuter, BSN, RN · Oct 28, 2015

I'm very excited to make a change in the world of nursing.

This is a lofty goal that is not rooted in reality unless, of course, you become a nurse leader, researcher or nursing lobbyist.

All workplaces have unspoken, subtle politics that lurk beneath the surface. This is especially true for nursing homes and skilled nursing facilities. My advice is to lay low until you develop a proficient skill set and gain more confidence.

The new nurse who wants to make sweeping changes is often the one who becomes disillusioned most quickly. Develop proficiency in your role before embarking on change. Good luck to you!