Delegation During Clinical

  1. 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it common for students to not practice delegation and proper communication skills or is that school's way of teaching outdated?
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    16 Comments

  3. by   rnhopeful82
    I am not sure about others, but in my school we have our own patients and can ask for help/guidance with a patient to nurses or staff but it is usually directed to our instructor (ours also works in the same hospital). We don't delegate anything to anyone, often we are there if an aide or nurse needs help turning, getting water, walking with the patient or feeding if we are available. So, no, in mine we don't delegate anything and it would never even occur to me that I should in this setting.
  4. by   sillymu
    Quote from rnhopeful82
    We don't delegate anything to anyone, often we are there if an aide or nurse needs help turning, getting water, walking with the patient or feeding if we are available. So, no, in mine we don't delegate anything and it would never even occur to me that I should in this setting.
    They teach us to work as both the aide and the nurse and if we need help with something we can delegate tasks like turning, bathing, getting blankets. Often we're the ones walking or feeding, but if we need help we are allowed to ask and assign someone to that task appropriately. They prefer for us to get used to effective communication and task appropriate delegation. I just wanted to make sure what she said wasn't crazy. Thanks for the input
  5. by   tonyl1234
    Be careful about delegating when you're not licensed.

    First off, if you're not a manager, you absolutely do not under any circumstance give an order if you expect people to actually cooperate with you. They won't, and you'll be stuck doing it yourself. Instead you ask them, or you tell them the patient asked for something, or that something needs to be done. Basically, either ask them to do it, or tell them the situation.

    Delegating work isn't as black and white as schools make it seem. It's a very fine line to what every healthcare worker should delegate and what you legally can't. Most of it, you legally can't. And I think that's what your teacher was aiming for. Basically that you understand the limits to what someone unlicensed can control and that you're able to coordinate your teamwork within those limits. Basically, you can't assign tasks, at all. You're not an RN until you have that license in your hand. But you can coordinate the tasks that are already assigned. An example is if you're sent to help an aide bathe a patient. One of you has to take charge. You're both already assigned that bath. You're not allowed to assign that aide to help, but once an RN does, or he volunteers his help on his own or agrees to help you after you ask for help, you can tell the other aide what parts of the bath he's doing while you do the rest.

    Then there's a difference between delegating, and communicating a situation, which is the loophole to the law. If a vent patient asks to be suctioned, you can't tell the RN or RRT to suction the patient. But you CAN tell the RN or RRT that the patient asked to be suctioned (as long as the patient really did ask to be suctioned. Lying can cause some problems for you.), which basically means suction the patient. Or you can tell an aide that the patient has to use the bathroom, but you can't tell the aide to take the patient to the bathroom.
  6. by   apmarquez
    In my nursing program we don't practice delegation which sucks but we still learn a lot about it. It seems more common for nursing schools not to practice delegation in clinicals.
  7. by   sillymu
    tonyl1234 I completely understand what you're saying. They teach us that delegation involves a lot of assigning people to tasks, but it's presented to us in a way that only the charge nurse is allowed to "assign". We know that once we become nurses we can assign tasks, but we're taught to do it in a manner where we're asking rather than telling them what to do. None of the nurses at the smaller hospital "tell" us what to do it's always in an asking manner. It's like working on a group project almost. "If you provide this part of the care, I'll do the other". We make sure we're always communicating throughout the shift.

    Also I would never have someone doing something that is out of their scope of practice. I'm usually delegating tasks like Q4 vitals and turning. When it comes to communicating with the nurses it's along the lines of dressing changes and specimen collection.

    I know I'm not licensed so I know I need to walk a very straight line and be careful with assigning tasks. Our professors on the other hand tell us all the time that we're working under their license and if we need something done or help with something we can delegate appropriately. Because of that, I assumed it was common practice at other schools.
  8. by   FolksBtrippin
    I graduated in 2016. We never delegated at all as nursing students. We were the ones getting ice, blankets, etc. I am really surprised to hear that this is being done. Delegation has probably been identified as a deficit in new nurses. If you are at a good school, they develop their curriculum around that stuff, which is good. IMO, delegation is hard for nurses because of management structure, but that is another topic.

    If this particular instructor does not really want you delegating, then don't. You will not be worse off for that. If staff do not give you details, then practice getting a good history by looking things up yourself. Work on whatever this particular instructor wants you to work on. I promise you will not learn less by not delegating during this clinical.
  9. by   Sour Lemon
    Students showing up on the unit and assigning tasks to CNAs would not have gone over well.
    As students, we always took care of the "CNA tasks" ourselves. There was no need to delegate as we weren't doing anything near what an actual nurse does (although it seemed like we were at the time).
  10. by   NewEnglandRN16
    I keep writing and erasing.

    When I was a student nurse, my job was do everything for that patient. I did vitals, am care, transporting to tests, set up for meals, blood sugars, etc. If it was my day for meds I would communicate that to my nurse. If an ambulatory pox was needed, the SN did it. If I had access to the computers I did the documentation. There wasn't anything to delegate unless my shift was over and I reported back to the nurse.

    Today as a nurse, I had a SN with my patient who did all of that. I still need to do an assessment but the SN did all the care. And she was excellent too. She did not have access to the computer and therefore only needed the tech to input the I&Os. This particular patient was actively diuresing and was frequently either incontinent or being put on the commode. If she needed help she looked to her fellow students for it. That's how this group works. They also use one student as a charge nurse who takes who doesn't have an assignment and can help. This is how they practice delegation.

    I love the students on my floor. But they are a guest that are learning. I still need to do my job. I delegate because it's necessary for my day not for practice.
  11. by   sillymu
    All of this feedback is great! The hospital in our town has a great relationship with our school so I think they're used to having us there and helping us learn the role of the nurse and develop communication skills and understanding certain things before we're out in the world and not really understanding what's going on and why.

    The hospital we're at now we're in charge of everything for that patient for the day, computer access or not, but the problem is communication skills are severely lacking between floor staff and doctors and students in general. This is a teaching hospital as well so it's alarming going into a situation where people don't communicate with each other or even want to teach certain skills. That's the main reason I asked the question about delegation. Communication is key in healthcare and if no one is talking how can we coordinate care for the patient?

    My main concern about this and delegation is that we're literally taught and told if you need help with something because you have three patients and you're doing a dressing change and another needs to go to the bathroom and the other needs to be fed their meal, you can't be expected to be in three places at once so you assign people to go do these things and make sure they get documented as such. I'm not literally walking in the hall and saying "you need to go put bed 2 on the commode" I'm saying "I'm doing a dressing on 18, I know bed 2 needs the commode can you go make sure they get there?" Or "Can you please fed 24? I'm doing a dressing change and I'll be in shortly". We're taught this way for delegation and it's effective.

    It's just difficult having had this experience for a full year and then going somewhere else and they, as a facility, lack communication skills as a whole. I understand all facilities aren't the same so I'll get over it. Just wanted to vent/talk about it.
  12. by   NewEnglandRN16
    But also part of nursing is prioritizing. If you know someone has to go to the bathroom, toilet them first and then do your dressing. Feed another patient before doing a dressing.

    I'm a big fan of checking in frequently and offering tolieting, repositioning, beverages, etc. It keeps down call bells. That way when you do an task you'll less likely be interupted.

    And I commend you for not super defensive.
  13. by   Horseshoe
    Quote from sillymu
    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).
    You, as students, are "delegating" tasks to licensed nurses?????

    Quote from sillymu
    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?
    Being able to communicate well is certainly important, but delegating (as you have described it) just seems to be robbing you of learning opportunities. I don't see this as "outdated" at all, as I doubt many nursing schools were doing this in the past. In my school, we did everything-no delegating to CNAs-because that is how you learn to do all of the tasks a nurse could be required to do. Not all units have CNAs, so you need to be able to do complete patient care.

    I'm not surprised the nurses seem less than enthusiastic to have your student group in the unit, given what you have related.
  14. by   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.
    Last edit by Orion81RN on Sep 26 : Reason: Spelling

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