Help with delegation

NurseKatie08, MSN · Feb 6, 2009

Respect your CNAs! If you don't do that, you won't get anywhere when it comes to delegation.

Most of the CNAs I work with are old enough to be my mom & have been doing this for years. I am 5 months in as a new RN with 2 years CNA experience prior to that. When I was a CNA, I worked with many nurses who treated me like garbage and didn't know the value of the words "please", "thank you" and/or "when you have time". I always vowed that I would never be like that.

In fact, just tonight I was in the middle of assessing my new admission when she mentioned that she had been incontinent and needed to be changed. I put on the call light because I needed a new brief for her & some help for a boost. I started changing her as soon as the CNA I was working with brought in the brief, and we finished & boosted her up together. The CNA looked at me and said "Katie, you've been a CNA before?"---and I replied that I had. I think she was shocked that I took the initiative because many nurses at my facility aren't as quick to help with ADLs as I am. I think the princple of "you scratch my back, I scratch yours" applies here...I help them out, & they in turn make it easier for me to delegate to them. The way I look at it is, we are all there for the patients, so we should just all help each other.

ChristineN, BSN, RN · Feb 6, 2009

Respect your CNAs! If you don't do that, you won't get anywhere when it comes to delegation.
Most of the CNAs I work with are old enough to be my mom & have been doing this for years. I am 5 months in as a new RN with 2 years CNA experience prior to that. When I was a CNA, I worked with many nurses who treated me like garbage and didn't know the value of the words "please", "thank you" and/or "when you have time". I always vowed that I would never be like that.
In fact, just tonight I was in the middle of assessing my new admission when she mentioned that she had been incontinent and needed to be changed. I put on the call light because I needed a new brief for her & some help for a boost. I started changing her as soon as the CNA I was working with brought in the brief, and we finished & boosted her up together. The CNA looked at me and said "Katie, you've been a CNA before?"---and I replied that I had. I think she was shocked that I took the initiative because many nurses at my facility aren't as quick to help with ADLs as I am. I think the princple of "you scratch my back, I scratch yours" applies here...I help them out, & they in turn make it easier for me to delegate to them. The way I look at it is, we are all there for the patients, so we should just all help each other.

I agree Katie. The PCT's on my floor call me "self-sufficient." This doesn't mean I don't delegate, but I'm not afraid to get my hands dirty, and am not going to ask them to do something if I'm not busy.

SummerGarden, BSN, MSN, RN · Feb 6, 2009

i think the two of you above are making the assumption that the op is trying to delegate everything to her cna, so she has nothing to do. if the op could do all of the nursing tasks, then there would be no need for cnas!

i too was a tech where i started off cleaning up before i provided other forms of patient care. i too have been treated like garbage so i know what you mean... however, i have a similar problem with the cnas (older ones who think they know everything and are studying to attend nurisng school and younger who are in nursing school and think that they are above doing his/her job or that they too know everything). coming from a similar background then the two of you, my advice is different....

op: you do not need to know why they are behaving the way they do. it does not matter.... if you have other nursing tasks that need to be performed and you need the cna to jump in and help, then you need to delegate.

i do not recall telling the nursing staff "no" or making excuses to get out of work because i did not like so-and-so. i acted and behaved professionally no matter how poorly the one delegating to me behaved. i was not owed an explanation to do my job and you do not owe anyone an explanation (i know that not everyone is like this but this is my expectation). if you delegate a task and it is accepted by a cna who can perform the task, then the tasks needs to be done. if it does not get done, you are ultimately responsible and so you need to be sure to let him/her know that this behavior is not acceptable. if confronting the cna in a professional manner does not work, then you need to take it up higher channels.

by the way, my biggest thing at the beginning of a shift is that i communicate my expectations to the staff even if i have worked with him/her before. i let them know if i will be performing most of the primary care that shift given my patient load or not! the expectation is that if i delegate something and the cna who is competent and accepts the task, but he/she is unable to perform the tasks later, then he/she is to tell me in advance; i should not have to find out later when i am following up!

i learned how to delegate as a nurse extern. i am in no way perfect at this yet, but working full-time and coming on here has helped (daytonite is a good one to get advice from ... she has decades of experience and well read). plus, "please" and "thank you" can go a long way. good luck to you.... :twocents:

NurseKatie08, MSN · Feb 6, 2009

i think the two of you above are making the assumption that the op is trying to delegate everything to her cna, so she has nothing to do. if the op could do all of the nursing tasks, then there would be no need for cnas!

no, i surely was not making that assumption. i was simply making the point that ease of delegation comes from mutal respect with both parties involved. nowhere in my post did i state or imply that she was drying to dump everything on her cnas so that she had no work. in fact, my post wasn't really referencing her own situation, i was simply stating what worked for me.

i too was a tech where i started off cleaning up before i provided other forms of patient care. i too have been treated like garbage so i know what you mean... however, i have a similar problem with the cnas (older ones who think they know everything and are studying to attend nurisng school and younger who are in nursing school and think that they are above doing his/her job or that they too know everything). coming from a similar background then the two of you, my advice is different....

op: you do not need to know why they are behaving the way they do. it does not matter.... if you have other nursing tasks that need to be performed and you need the cna to jump in and help, then you need to delegate.

i do not recall telling the nursing staff "no" or making excuses to get out of work because i did not like so-and-so. i acted and behaved professionally no matter how poorly the one delegating to me behaved. i was not owed an explanation to do my job and you do not owe anyone an explanation (i know that not everyone is like this but this is my expectation). if you delegate a task and it is accepted by a cna who can perform the task, then the tasks needs to be done. if it does not get done, you are ultimately responsible and so you need to be sure to let him/her know that this behavior is not acceptable. if confronting the cna in a professional manner does not work, then you need to take it up higher channels.

by the way, my biggest thing at the beginning of a shift is that i communicate my expectations to the staff even if i have worked with him/her before. i let them know if i will be performing most of the primary care that shift given my patient load or not! the expectation is that if i delegate something and the cna who is competent and accepts the task, but he/she is unable to perform the tasks later, then he/she is to tell me in advance; i should not have to find out later when i am following up!

for me, this is why giving cnas a verbal report at the start of the shift has been important. i always lay out exactly what my expectations are regarding each of my patients, and let them know that they should seek me out if there are any problems with the task getting completed. i also let them know what and how much my patients should be doing indepedently, since i work on a rehab unit.

i learned how to delegate as a nurse extern. i am in no way perfect at this yet, but working full-time and coming on here has helped (daytonite is a good one to get advice from ... she has decades of experience and well read). plus, "please" and "thank you" can go a long way. good luck to you.... :twocents:

kellykelly · Feb 6, 2009

In my facility the responsibilities of the CNAs are clearly spelled out. They have duties that they are required to perform. Being my servant isn't one of them, but you do have RNs that will walk all the way down the hall to find one of them and ask them to put their own patient on the bedpan--walking right past the room to do so! That is very irritating to me. I can't stand lazy nurses. If my patient calls and I'm not busy, I tend to whatever it is myself. Ice water, gown change, change the bed/diaper, you name it. When I need a CNA to do something for me I always ask politely. In exchange, they tell me they're glad when I'm working because I always say please and thank you and don't think I'm above doing the dirty work. As a result, it's never hard for me to get help from others when I need it.

Respecting others and using manners never hurts! I don't really get the "delegation" thing I read about on here. It seems that in some places, it's sort of an issue? I know other hospitals and floors aren't necessarily run like mine but it seems that to many people (and no, I'm not talking about the OP) delegation means telling others what to do instead of asking and working as a team. Of course if you have a lazy co-worker with a bad attitude, niceness doesn't always work, but you can be firm AND polite at the same time.

Virgo_RN, BSN, RN · Feb 6, 2009

Hi, I am precepting in an ADN program and working on delegation, well, actually having issues with delegation to a certain type of CNA that feels she is older and knows more than I, which she may in some things. I have been very respectful of that and yet I can't seem to muster the courage to delegate. What are some experiences and some of the pro's and con's in delegation you've had?

Older, experienced CNAs who have been at it for a long time have developed their own ways of doing things, and can understandably chafe at a student nurse who may not know a whole lot telling them what to do. From their point of view, you are an outsider, not one of the nurses that they are used to working with, and here you are trying to tell them what to do. You have to respect the fact that, as a student nurse, you are an outsider. Treat the CNA like an equal, not a subordinate. Instead of instructing her to do a task, ask her if she has time to help you with XYZ. Use her name and say please and thank you.