When to delegate to CNAs?

  1. This week a good friend of mine, who has been a CNA for almost a decade sat down and shared some words of wisdom with me. She told me that many nurses abused their CNAs and made them do things that the nurse could have easily done, but they felt compelled to ask my friend to do it because they seen that she wasn't busy for a whopping 5 minutes. She told me to never over use the CNAs and to never forget that they're hard working and need to be cut some slack sometimes.

    None of us want to be used and abused, so I wanted to come on here and ask others what their honest opinions are on when it is appropriate to delegate tasks to a CNA?

    I am a new grad and was hired in the ER, so I am not sure whether we have CNAs in the ER, but I do believe we have techs who have similar scopes of practice.

    Before I became a RN, I was a nurse apprentice, which is exactly like a tech. I never felt abused by my nurses, but I do hear other CNAs often talk about feeling like they're taken advantage of.

    So with that being said, what are some appropriate tasks to delegate to your CNA? Should you only delegate when you're busy doing something else, or are there tasks you always ask the CNA to do?

    I am so grateful for CNAs and bless their hearts for all the work they do and all the help they provide to us and our patients. We are all a team and I want to make sure I am asking them for help during appropriate times.

    Thanks everyone!
    Last edit by Brian S. on Feb 28
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    About Alexx_xox, ADN, RN

    Joined: Dec '17; Posts: 171; Likes: 141
    from US
    Specialty: 1 year(s) of experience

    19 Comments

  3. by   Ruby Vee
    CNAs and techs have different scopes of practice . . . at least in my state they do. Your state may vary.

    As a nurse, you have a much wider scope of practice than the CNA or the tech. You can only delegate what is within their scope of practice. You can do anything that they can do, but they cannot do your job. Many CNAs don't understand that. I'm not saying that your friend is one of them, but it is something to be aware of. If the CNAs are getting in all of their breaks and clocking out on time and you're still finishing up and/or charting, you're probably not delegating enough. (Although being brand new, it will take you some time to get up to speed.)

    Sometimes it's not a matter of what you delegate or how much you delegate but HOW you're delegating. We're all on the same team, and CNAs need to be aware of how much you value them. Take the time to get to know them as people, delegate fairly and kindly and make sure to express appreciation for a job well done. Also be aware that as a new nurse, you have MUCH to learn, and you can learn much from a CNA. I learned how to make an occupied bed, how to bathe a patient without leaving them a sopping, soggy mess, making a dressing change neatly and efficiently, how to set up dinner trays and feed patients and about 1001 other things from the NAs at my first job.
  4. by   Mmbaut
    Being a CNA since I was 18, I can definitely say I've been asked of too much. But it's all balance. There's been days I've ran around like a chicken with no head, and other days that I wonder if someone's playing a joke because it's so "quiet"."

    I wouldnt worry that you're asking too much, because from my experience, I let others know when I can't accommodate them. "Yea I'll get that done, but right now it's at the bottom of my list." That's my nice way of saying it problem won't happen

    At the same time, I've asked things of my nurse, very well knowing we're all busy. "Hey I need help pulling up this patient." "Mr. Smith is on the toilet, can you watch him while I go get clean socks?" Things like that.

    If they're CNAs interested in furthering their career, definitely ask them along. I'd love when my nurses would ask me to help with wound care, glucose checks, IV starts, cath insertions, etc. I'd help the nurse by keeping the patient on their side or whatever, and as the nurse was doing their procedure, she/he would walk us step by step. I was always learning to help the nurses!
  5. by   Wuzzie
    Good question. It's different for techs in the ED. They don't usually have "timed" tasks such as AM VS and FSBGs. Their tasks are much more random. My experience is they LOVE lab draws and EKGs so you shouldn't get any push back for those. They aren't usually so fond of the other stuff (nor should they be) but as a nurse you'll find yourself doing almost as much of it as they do because it's just quicker to do it together. The techs I worked with were wonderful. My Achilles heel is chunky puke. I can't do it. When I was new though, to prove I was a team player, I tried really hard to help clean it up. Once they say how awful it was for me I never had to deal with it again because they'd take care of it. Conversely I'd clean up the GI bleed poop if it bothered them. It seems in the ED there's much more give and take with the tasks. That may be a reflection of the fact that few things are "scheduled" so there's some leeway. The best way to ensure a good working relationship with them is to never make them work harder than you do.
  6. by   Been there,done that
    Knock off the grateful stuff. The CNA role exists only.. to ASSIST you.

    You will not be asking for help, you will be directing patient care.
  7. by   NightNerd
    When delegating, I keep in mind the following:
    -I love the techs on my unit BECAUSE I know they will do anything and everything for our patients, so I know they don't automatically resent me for asking them to do something.
    -They like and respect ME because I've demonstrated that I'm not above any task and that I will always help them when they need it. If I can't right away, I let them know why and tell them when I can help if they still need it.
    -Consequently, we have an excellent balance. If I absolutely cannot do something, they trust that I am prioritizing. If they are drowning, I get vitals for people as I give meds, bring fresh waters on final rounds, whatever. And, just saying, cleaning up an incontinent patient is a really good time to do your skin assessment...

    Unless you are a sociopath or work with them, it really boils down to developing good relationships with your coworkers. I am lucky enough to have that, and it makes my work life so much more pleasant.
  8. by   not.done.yet
    I second everything NightNerd said above. I took time to get to know the CNAs, ate lunch with them whenever possible, bought them lunch on difficult days. I helped whenever possible and on the rare moments I found myself with spare time, I went to them to see what was still on their list that I could accomplish so that we both were less stressed. I also made sure to involve them in the patient's care. I gave them brief report each morning, let them know what I was most concerned about with each patient so that they could alert me if they saw something that might indicate the need for me to get in there and assess them. Basically I treated them like a member of my team. They appreciated it and I am still friends with many of them, though no longer at the bedside and now with a different employer.

    Treat others as you would like to be treated and recognize you have a lot to do that they just don't understand. Don't be too timid to delegate, but delegate in partnership, not in dictatorship. Whether or not you could do something yourself is NOT the measure. Almost everything on the CNA list of duties are things I technically could accomplish myself. However, I have my own list of duties, as do you, almost all of which the CNA could not accomplish. If I am doing their job plus my own, guess who suffers? Me, yes...but most of all the patients. It takes practice, finding the balance between delegation and doing for yourself. Telling others what to do can be uncomfortable, especially if dealing with someone recalcitrant or hostile. You just have to push past that and remember they have a job and so do you..and theirs is to assist you in caring for the patients. You can do anything the CNA can do, but the CNA cannot do most of what you are required to do. Whether or not they understand that isn't really your issue...it is theirs.
  9. by   ruby_jane
    A lot will depend on what your policy allows and what their scope of practice includes. So, I'd research what your policy says.
  10. by   BrandonLPN
    It boils down to: they can't help us with our specific licensed nurse duties, which take up the bulk of our time. Therefore delegation is mandatory.

    If the CNAs on my team, on the rare occasions I'm not swamped busy, see that I'm willing to toilet someday or put somebody to bed, they will be more willing to accept my delegation without being resentful when I am busy. They can see the difference.

    There are a lot of little teamwork things you can do to earn their respect and trust.

    We often forget to sincerely thank them when they're doing a good job.

    We need to listen to the concerns they bring up, and show them we take these concerns seriously and follow up on them. I try to keep them in the loop about what's going on. Instead of just telling them to go get a weight on Mrs Jones, I will explain that Mrs Jones has been showing increased signs of CHF, and it's importnat that we know she's not resting too much fluid. They then know why this is a priority and why I'm asking them to do it. They genuinely do care for the patients, but it's hard for them to separate what they see as busywork from what's important.
  11. by   Alexx_xox
    Quote from NightNerd
    When delegating, I keep in mind the following:
    -I love the techs on my unit BECAUSE I know they will do anything and everything for our patients, so I know they don't automatically resent me for asking them to do something.
    -They like and respect ME because I've demonstrated that I'm not above any task and that I will always help them when they need it. If I can't right away, I let them know why and tell them when I can help if they still need it.
    -Consequently, we have an excellent balance. If I absolutely cannot do something, they trust that I am prioritizing. If they are drowning, I get vitals for people as I give meds, bring fresh waters on final rounds, whatever. And, just saying, cleaning up an incontinent patient is a really good time to do your skin assessment...

    Unless you are a sociopath or work with them, it really boils down to developing good relationships with your coworkers. I am lucky enough to have that, and it makes my work life so much more pleasant.
    Absolutely love everything you said. I like how you said that you are not above any task, which is so true. My friend often mentioned that a lot of nurses would always make her clean the patients while the nurse absolutely never helped with it, I find that rude and unfair. And like you said, its an excellent time to assess the skin on the back.
  12. by   Alexx_xox
    Quote from not.done.yet
    I second everything NightNerd said above. I took time to get to know the CNAs, ate lunch with them whenever possible, bought them lunch on difficult days. I helped whenever possible and on the rare moments I found myself with spare time, I went to them to see what was still on their list that I could accomplish so that we both were less stressed. I also made sure to involve them in the patient's care. I gave them brief report each morning, let them know what I was most concerned about with each patient so that they could alert me if they saw something that might indicate the need for me to get in there and assess them. Basically I treated them like a member of my team. They appreciated it and I am still friends with many of them, though no longer at the bedside and now with a different employer.

    Treat others as you would like to be treated and recognize you have a lot to do that they just don't understand. Don't be too timid to delegate, but delegate in partnership, not in dictatorship. Whether or not you could do something yourself is NOT the measure. Almost everything on the CNA list of duties are things I technically could accomplish myself. However, I have my own list of duties, as do you, almost all of which the CNA could not accomplish. If I am doing their job plus my own, guess who suffers? Me, yes...but most of all the patients. It takes practice, finding the balance between delegation and doing for yourself. Telling others what to do can be uncomfortable, especially if dealing with someone recalcitrant or hostile. You just have to push past that and remember they have a job and so do you..and theirs is to assist you in caring for the patients. You can do anything the CNA can do, but the CNA cannot do most of what you are required to do. Whether or not they understand that isn't really your issue...it is theirs.
    I think it's so important to develop those relationships early on with all members of the team. Being able to work together and truly respect one another is very important. Thank you
  13. by   Glycerine82
    Never delegate out of convenience and never delegate something outside of their scope. If you have time to do it yourself, do so.

    A good CNA is worth their weight in gold and if you are good to them your shfits will be so much smoother
  14. by   Leader25
    you said:"I learned how to make an occupied bed, how to bathe a patient without leaving them a sopping, soggy mess, making a dressing change neatly and efficiently, how to set up dinner trays and feed patients and about 1001 other things from the NAs at my first job"

    I am just curious ,how come you did not learn this while in nursing school?How did you pass clinicals?.

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