How to deal with nurses who respond they are busy when you delegate

[biju27]

Good evening, I am a new manager with only one year experience and over the last year I changed my job. Currently, I am responsible for 41 employees, andI can say I have good RN/patient census. One nurse is responsible for maximum of 15 patients. Here I can say that we are not always full. I find my CNAs very compassionate, and caring. They listen and look for my opinion and advice. The problems I am having is with the nurses. I constantly find their lack of knowledge. I offer to teach them, however I feel that they do not care, and do not want to improve. I gave to all their job description, the only thing they care concerned with is to pass their meds. They lack critical thingking, do not know how to prioritize. One of their responsibility is to create care plans for their patients. When I remind them what else is needed to be done for their patients, the response I get is, "I am too busy or No, it is too much." I did written verbal warnings, however somehow this does not work. As a result, I do all of thier paper work. It is overwhelming for onr person to do all, especially when I have families that are very demanding and expect from me to update them about their relatives on daily basis. Please, help me. I am willing to do what it is needed to be done. In addition, I do not have the support from HR who made me aware that the facility is not in the position to fire anyone.

[amoLucia]

I've been on both sides of the fence - staff & supervisor & inservice. What I see as the biggest obstacle to better documentation is the staff's lack of knowledge. Some folk just don't know how to do it any better. No one has expected any better of them and the more senior staff may never even had strong skills to start with (and if you don't use it, you lose it).

Nsg school care plans are flufy & stuffy things with all the R/T and A/E/B thingies. My LTC/rehab care plans are short, sweet & to the point. I'll never win any school awards!!! Never really cared to do them, but I had to start - rusty at first, but it got easier. I developed my own sample care plans that I would just tweak for each pt. As long as basic CPs were started on admission, they could be refined any time by anyone. And that was the expectation of staff. I would always date & sign off my care plan entries just so I got my credit due.

My point here is that the staff need really good education with resources, opportunities to practice writing samples, safe feedback, etc. Just like school. IMHO, you need a really fine-tuned education program for care plan & charting improvement. Provide the education, expect to see it in use, gently correct & refine. If they don't know to know to know to know, they can't & won't do it. Sounds to me like they're playing passive-agggressive with you now.

You've got the disciplinary piece in place - I do like PP Orca's comment of supervisor vs overseer. And there are some good alternative options offered by others. Good luck.