How to effectively delegate in nursing on a unit

[starlitex1280]

Hi everyone,

I'm a new RN but not a recent grad. My experience includes 7 years being an LPN and 4 years working in the lab at a hospital. However, I'm currently having difficulty in delegating tasks on the floor. I don't know how often it occurs in nursing in general, but as a new RN, I have a tough time delegating to assistive personnel. For example, I'm following basic protocol in delegation such what to appropriately delegate to the PCA:

-picking up medication from pharmacy
-sending them to drop of specimens to the lab
-asking to change a patient and offering assistance when needed
-giving socks, water, or an extra towel or blanket etc. for a patient
-taking vital signs (stable patient except when critical)
-emptying urinals, offering bedpans to patients, assisting them with personal needs

These are the day-to-day things that matter even though they may seem like simple to do, one person cannot do everything at once. I see now that the responsibilities of an RN are much more than the LPN and delegation is something I need to improve on. I always ask nicely or politely to the PCA when delegating tasks however, it seems like 50% of the time I wind up doing the tasks myself.

Here are the following common responses I get from asking the PCAs in a nice way about delegating tasks:

"You can't do it yourself?"
"I'm on break"
"Why can't you ask the other PCA to do it? I'm doing a one-to-one"
"Sorry, I'm busy right now"
"I'm on this side, where's the other PCA on that side?"

In addition, they're no where to be found at times. I find myself going to the charge nurse or nurse available for help. I can understand when the floor gets heavy with admissions and discharges. However, asking something basic and in a polite way shouldn't have to delay patient care. I know this is a new role for me however, I feel like my morale is very low because it's creating such a burden to ask someone for help. I want to help out patients the best way I can but I cannot do it by myself. I cannot give medication, follow up with doctor's orders, chart, monitor critical patients, turn and lift patients, offer a bedpan, give pain medications, and do an admission etc.. all by myself?!?! It's not possible, it really isn't.

To all nurses reading this, I would greatly appreciate any advice you can give me and to give other new nurses out there who feel the same way. I still think that nursing is a great profession. New things to learn...you're there with the patient when they are most vulnerable and utilizing nursing skills to help them at their time of need is awesome to me. But, I'm almost burning out by bedside nursing. Thank you all for reading my post. Any help on this matter is greatly appreciated.

[Party_of_five, BSN]

Delegation is hard when EVERYONE is busy. Nursing is a team sport. My advice would be to just do the best you can.

Don't go hunt down a CNA to ask them to get water or ice or whatever just do it yourself.

If it is their job to do VS then they should be doing them. If they aren't that sounds like a conversation that needs to be happening. If you are worried about a pt and want to check vitals do it yourself.

Some the the excuses you listed are legitimate, i.e. the 1:1 pt, on break or even the "I'm busy one" but the correct response should be "I'm _______ right now but I can help you when I'm done" not just "NO I can't. "

[Ella26, BSN, RN]

I don’t work on a hospital floor and never have. But, I’m interested in finding out the best way to improve on delegation, just for personal knowledge.

Also, something to add... and this is not to be rude to you, but genuinely real issues to consider...

1) Are the PCT/CNAs providing these same responses to the veteran/other nurses when they ask?...

2) Could it just be you?... I.e., your new, or personality clash...

3) You say you ask nicely, can you provide examples of how you ask them? Is it your tone?...Perhaps, your perception of how you come off is wrong?...

4) Speak with them privately and ask them “How can we work better as a team on tasks that need to be done to take care of our patients?” Meaning how would they prefer to be asked. Some people really don’t like being “told”... And are more helpful when asked...

Just some points to consider....

[starlitex1280]

6 hours ago, Party_of_five said:

Delegation is hard when EVERYONE is busy. Nursing is a team sport. My advice would be to just do the best you can.

Don't go hunt down a CNA to ask them to get water or ice or whatever just do it yourself.

If it is their job to do VS then they should be doing them. If they aren't that sounds like a conversation that needs to be happening. If you are worried about a pt and want to check vitals do it yourself.

Some the the excuses you listed are legitimate, i.e. the 1:1 pt, on break or even the "I'm busy one" but the correct response should be "I'm _______ right now but I can help you when I'm done" not just "NO I can't. "

Thank you for your response! You're right, it is definitely a team effort. Will definitely consider what you mentioned and try to apply it. I like the last example you said "I'm ____ right now, but I can help you when I'm done". It sounds negotiable and diplomatic. Will definitely work on similar responses. Thanks!

[starlitex1280]

5 hours ago, Ella26 said:

I don’t work on a hospital floor and never have. But, I’m interested in finding out the best way to improve on delegation, just for personal knowledge.

Also, something to add... and this is not to be rude to you, but genuinely real issues to consider...

1) Are the PCT/CNAs providing these same responses to the veteran/other nurses when they ask?...

2) Could it just be you?... I.e., your new, or personality clash...

3) You say you ask nicely, can you provide examples of how you ask them? Is it your tone?...Perhaps, your perception of how you come off is wrong?...

4) Speak with them privately and ask them “How can we work better as a team on tasks that need to be done to take care of our patients?” Meaning how would they prefer to be asked. Some people really don’t like being “told”... And are more helpful when asked...

Just some points to consider....

Thank you for your response! I like the possible options that you listed.

1) Depends on the nurse they're helping. I do find that new nurses get similar responses like me.

2) Perhaps. I'm fairly new on the unit and perhaps it could be a personality clash? I'm soft spoken and non-confrontational. Most times what it would appear that the PCA is delegating to me. For example, offering suggestions after vitals are recorded. Telling me what I think I should do in certain instances because I'm new.

3) It's hard for me talk loud. So most of the time, I'm quiet and asking nicely doesn't seem to cut it in terms of delegation half of the time.

4) This is a great suggestion! I will definitely consider this the next time I'm on the unit. It's true, some people don't like being told what to do. However, certain ways of saying things can make all the difference. Thanks!

[Queen Tiye, RN]

I read most of what you wrote. It sounds like you may possibly asking aides to do things that you can do yourself. For instance, giving assistance with elimination hygiene when needed is not enough. If you enter a room and the Pt is incontinent, it’s your responsibility to clean them up. Telling them that the aide will be in shortly and walking out is neglect (I know you didn’t say this it’s just an example). Also, because the aides have responsibilities that are specific to their job description doesn’t mean that the nurse is no longer responsible for the tasks. A lot of nurses with no prior inpatient care experience make this mistake.

It sounds like your aides are hiding from you and don’t want help because they resent you for some reason.

A nurse entered a contact room after me — I was the aide. We were both gowned and I was going about my morning tasks on a very heavy floor. The nurse was going to provide wound care and didn’t bring all her supplies. She couldn’t do anything else without whatever she forgot. She asked me to go get it and proceeded to stand at the foot of the bed doing nothing. I said sure and kept on doing my work in the room. She didn’t want to ungown and regrown, and neither did I, but she was the one who forgot her supplies. She looked at me like I was crazy, took off her gown and went and got her supplies herself. If she had started the wound care and needed help to finish would be a different story. She saw me as a lackey, not a team mate. This was her attitude with all of the techs. She learned, though.

Techs respect us when they see you are willing to work along side them and are competent in basic patient care.

[starlitex1280]

1 hour ago, Queen Tiye said:

I read most of what you wrote. It sounds like you may possibly asking aides to do things that you can do yourself. For instance, giving assistance with elimination hygiene when needed is not enough. If you enter a room and the Pt is incontinent, it’s your responsibility to clean them up. Telling them that the aide will be in shortly and walking out is neglect (I know you didn’t say this it’s just an example). Also, because the aides have responsibilities that are specific to their job description doesn’t mean that the nurse is no longer responsible for the tasks. A lot of nurses with no prior inpatient care experience make this mistake.

It sounds like your aides are hiding from you and don’t want help because they resent you for some reason.

A nurse entered a contact room after me — I was the aide. We were both gowned and I was going about my morning tasks on a very heavy floor. The nurse was going to provide wound care and didn’t bring all her supplies. She couldn’t do anything else without whatever she forgot. She asked me to go get it and proceeded to stand at the foot of the bed doing nothing. I said sure and kept on doing my work in the room. She didn’t want to ungown and regrown, and neither did I, but she was the one who forgot her supplies. She looked at me like I was crazy, took off her gown and went and got her supplies herself. If she had started the wound care and needed help to finish would be a different story. She saw me as a lackey, not a team mate. This was her attitude with all of the techs. She learned, though.

Techs respect us when they see you are willing to work along side them and are competent in basic patient care.

Thanks for your response! As far as basic care needs, I feel like sometimes I wind up going back and forth the patient room gathering meds, giving patients gowns/towels when requested, giving pain meds, giving an extra cup of water, emptying urinals at once. Of course if it's something basic, I'm more than willing to help out and offer assistance. But let's say you're doing an admission, another patient asks for pain meds, then another patient requests for water, then another patient is going to be discharged, there's more scheduled medications to give and it's not complete because it wasn't brought up by pharmacy, the lab calls for critical value, a family member asks to speak with the doctor, and pt came back as a fresh postop etc. It can be overwhelming and I know we all have to work as a team. Priority and delegation become extremely important. That's another thing I'm trying to work on too...priority. However, delegation is one of the hardest things for me.

With the example you provided, I would have been more than willing to ungown and regown just to get supplies if I were missing something. Like if the aide was helping with positioning or something, I would have gone out the room to pick up extra supplies. I would be more than willing to help, but it seems like it's not reciprocated back as much as I would help them.

This is all a learning experience and I do appreciate your example. It does give me some insight into how I can better approach others in delegating tasks. Thank you!

[Ella26, BSN, RN]

14 hours ago, starlitex1280 said:

Thank you for your response! I like the possible options that you listed.

1) Depends on the nurse they're helping. I do find that new nurses get similar responses like me.

2) Perhaps. I'm fairly new on the unit and perhaps it could be a personality clash? I'm soft spoken and non-confrontational. Most times what it would appear that the PCA is delegating to me. For example, offering suggestions after vitals are recorded. Telling me what I think I should do in certain instances because I'm new.

3) It's hard for me talk loud. So most of the time, I'm quiet and asking nicely doesn't seem to cut it in terms of delegation half of the time.

4) This is a great suggestion! I will definitely consider this the next time I'm on the unit. It's true, some people don't like being told what to do. However, certain ways of saying things can make all the difference. Thanks

You’re welcome. I hope this helps!

You’re welcome. I hope this helps!

[Queen Tiye, RN]

8 hours ago, starlitex1280 said:

Thanks for your response! As far as basic care needs, I feel like sometimes I wind up going back and forth the patient room gathering meds, giving patients gowns/towels when requested, giving pain meds, giving an extra cup of water, emptying urinals at once. Of course if it's something basic, I'm more than willing to help out and offer assistance. But let's say you're doing an admission, another patient asks for pain meds, then another patient requests for water, then another patient is going to be discharged, there's more scheduled medications to give and it's not complete because it wasn't brought up by pharmacy, the lab calls for critical value, a family member asks to speak with the doctor, and pt came back as a fresh postop etc. It can be overwhelming and I know we all have to work as a team. Priority and delegation become extremely important. That's another thing I'm trying to work on too...priority. However, delegation is one of the hardest things for me.

With the example you provided, I would have been more than willing to ungown and regown just to get supplies if I were missing something. Like if the aide was helping with positioning or something, I would have gone out the room to pick up extra supplies. I would be more than willing to help, but it seems like it's not reciprocated back as much as I would help them.

This is all a learning experience and I do appreciate your example. It does give me some insight into how I can better approach others in delegating tasks. Thank you!

Perhaps in this case, a little manipulation is in order. When you guys have your morning meetings — with the techs present — tell them they are the best, better than the techs on the other units. I guarantee they will try to live up to that praise. Don’t over do it, but make sure you say they are better than the other techs in the hospital.

[starlitex1280]

@Queen Tiye Thanks for that added tip! You're right, showing and validating appreciation of them is a great start! I'll try not to over do it but to make sure that they feel acknowledged. Thanks again!

[AceOfHearts<3]

I always liked to demonstrate to the aides that I wasn’t just pushing stuff off on them.

”Hi Ann Aide, Mrs. Smith in room 1 needs to use the bathroom. Can you please assist her while I give Mr. Brown his medication before he goes to physical therapy off the floor. Also, I’m sure Mrs. White in room 3 has been incontinent again and is due to be repositioned- I know she’s a heavy 2 assist so let’s tackle that together and I can assess her skin at the same time”

[starlitex1280]

@AceOfHearts<3 Thanks for the great examples! It feels empathetic and boosts teamwork morale. Thank you!