Delegation During Clinical

[sillymu]

I'm in semester 3/4 of an ADN program. My first two semesters I was fortunate enough to have a professor as a clinical instructor instead of an adjunct who doesn't spend time in our lectures at all. This semester I have an adjunct that has never attended our lectures or labs and it is her first time working with our school and first time as an instructor. I say all of this because our program is big on learning and teaching how to delegate tasks. As a result I have had two semesters of practicing this in a clinical setting where I am asking classmates, nurses, and aides to do things. It's a teaching hospital so we get lots of practice with communicating. Rural upstate New York area (130 beds).

Last week in clinical a few of us in my group asked our instructor (the new woman) about proper delegation at the hospital (in a large city 750+ beds) we're at because we felt that the nurses and aides were a little rude to us. When asking for help or information on patients they were hesitant to give report or completely dismissive which led to us spending more time looking things up instead of hitting the ground running at 0700. This is the hospital she works at so we thought she would give us advice. Instead we got "In my program we were taught how to delegate, but as nursing students we were told that we are below the aides so it's not your place to ask them to do things or expect them to be receptive."

This shocked a few of us because we're not taught that and she graduated from a BSN program 3 years ago. Is it common for students to not practice delegation and proper communication skills or is that school's way of teaching outdated?

[Orion81RN]

Wow, I'm picturing being the nursing assistant working and having a student try to delegate to me. Just...wow. In my opinion, this should be taught in class. But at clinical, aside from *asking* for assistance doing something like turning a heavy patient, you should be asking THEM, "how can I help? What can I do for you?"

I just posted a reply to a student yesterday who mentioned all the butt wiping she does in clinical. My reply was, take that as an opportunity to build your assessment skills. You are in school learning right now. Don't view ADLs as tasks. Of course, in your mind, you should be thinking, "If I'm the nurse, I would delegate this right now." But in school...do not pass up opportunities to care for patients.

I'll use my example I gave the other student. Let's say there is a patient admitted for pneumonia with dehydration and they need a bed bath. If you delegate that, you are missing a huge learning opportunity. Do the bed bath. Assess assess assess. Are they requiring a lot of assistance? Ask the patient how they get bathed at home. The pt is going to be weak when arriving. Are they improving, requiring less help day by day? Listen to their lungs sounds. What is their respiratory effort? Skin turgur? Strong pulse? Weak pulse? What does that tell you in relation to their disease process? Tie it together with the patho you are learning. Come up with a nursing diagnosis in your head for each patient you do a task for, and think of nursing interventions. On TOP of your already signed care plans. This all should take no time at all doing it while you are giving a bed bath. It takes a moment to feel a pulse and place your stethoscope to skin.

You're going to work with all sorts of personalities. Accept that this is how your instructor is and take the learning where you can get it.

[TheDudeWithTheBigDog, ADN, RN]

I agree with what you said with the bed baths, and using them as a learning opportunity, but within reason. We have to all remember, a student is not staffed by the facility. You're not there to be an aide, you're there to be a student. There has to be a balance. You have to be able to be with the nurse to learn how to be a nurse. If there's downtime, being able to review your patient with your instructor and really get a grasp on the planned care, and why it's being done, is infinitely more important than wiping an ass. That's what the aide is there for. We also prefer to do it ourselves, because ultimately, if the student didn't clean the patient, we're responsible for that patient not being clean. So us going back to do it over is inconvenient for the patient.

[Orion81RN]

I agree with what you said with the bed baths, and using them as a learning opportunity, but within reason. We have to all remember, a student is not staffed by the facility. You're not there to be an aide, you're there to be a student. There has to be a balance. You have to be able to be with the nurse to learn how to be a nurse. If there's downtime, being able to review your patient with your instructor and really get a grasp on the planned care, and why it's being done, is infinitely more important than wiping an ass. That's what the aide is there for. We also prefer to do it ourselves, because ultimately, if the student didn't clean the patient, we're responsible for that patient not being clean. So us going back to do it over is inconvenient for the patient.

I understand all sides of it as I was a patient care technician (CNA), nursing student, and now a nurse. I'm not saying the majority of your time should be spent doing ADLs. But when a student has to, they have to make the most of it for their own learning opportunity. I learned the hard way, as I ******* and moaned as a nursing student about doing so much ADLs. I know now that I was wrong.

As far as delegation, in OPs original post, she didn't make it clear that she was prioritizing and delegating by ASKING for the CNA to do something while she was in the middle of patient care. She cleared that up in a later post.

[Here.I.Stand, BSN, RN]

Well to be fair, "teaching hospital" typically means they have professional affiliation with a medical school.

You also have to realize that the staff nurse has the same workload whether students are there or not, and are not paid to teach the students. If you have a question about the pt, you should FIRST try to find the answer in the chart; if you are still confused, THEN ask. Ideally you should ask your clinical instructor however, as s/he IS there to teach.

Don't get me wrong, I actually enjoy working with students, and I will absolutely answer questions. But if a student asks me 1st simply because it's faster than investigating, the student will be directed on how to find the information.

I graduated back in 2003 so a while ago, and while we learned about delegation and could ASK the CNAs for help, we never delegated in the sense "please toilet this pt while I get meds" or anything.

Up until our final practicum we never had a full pt load. I think the most we had was 3... *maybe* 4 in med-surg (that might have even been only during practicum). Such a light assignment made it possible to provide ADL cares while also practicing assessments and other licensed-nurse things. The charge nurse/clinical instructor actually directed the CNAs NOT to do ADLs with the pts students would be working with.

[SiADH135, ADN]

3rd semester ADN student also, and we definitely do not delegate anything to anyone. We learn about it in NCLEX style questions and understand the concepts, but in the clinical setting we are there as "student nurses" nothing more, nothing less.