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.
I bribed my CNAs. Buy them a star bucks or lunch once in a great while and it’ll amaze you at how much they help out. Was definitely worth the small amount of investment capital. My day went smooth when I had those CNAs working for me.
Thank you for sharing this post @starlitex1280! I have been a registered nurse for over a year and struggle with delegation as well. I am soft spoken and really struggle; especially since a lot of the aides are older than me that have worked in the long term care facility for 10 plus years and have the attitude that they do only certain tasks and that's it. To be honest I've been slacking a bit since Covid 19, I was working on being more assertive and following up but I'm so exhausted I just do a lot of stuff myself.
The main responsibility the aids have besides ADLs is taking temperature, heart rate, respiration rate. No blood pressure for some reason. When I was a CNA I had to take all the vitals(different facility). I've been doing everything besides it takes 30 seconds to take a temperature and 30 minutes to chase down a CNA to get them to take vital signs. Even though it saves me an hour doing vital signs it kind of causes a problem, because some of the aids are good and do the vital signs. So we're doing something twice because a lack in communication/delegation. It's difficult because even though I know most of the aids at this point, I can't have 10 minutes left in the shift, see that 5 temperatures are missing. First of all, for the patients safety, if they have a temperature it needs to addressed in the beginning of the shift, and second, it's miserable to be late because of that.
I think it's really hard to feel out how to communicate with aids who refuse a task. Sometimes it's just about forcing myself to be assertive, especially if I ask for something to be done and it's just not. Sometimes they do forget because things get busy, sometimes I've had CNA's tell me it's not their job/patient. Sometimes it's as simple as asking nicely (and this works better if they work regularly with you and they see you help with bedpans, turns, getting water whatever) but sometimes you have to tell them it's their responsibility (Even this put nicely as possible makes me feel rude and awkward).
I've also had to call a supervisor once because an aid wouldn't move residents out of a room because it wasn't the right day to clean the room according to her. Not only does it look bad on me to call the supervisor, it wastes their time. Obviously it wasn't a lack of delegation or communication but respect from the aid, and I think this gets tricky. I do agree with @Ella26 that you have to observe if the CNA is only refusing tasks that you give them, or particularly being disrespectful to you, because maybe it needs to be brought up to a supervisor. I've had a few CNAs who give me a problem and I probably should've brought it to a supervisor, but I don't want the supervisor to brush it off and then it be miserable to work with the CNA because the behavior continues and on top of it they're angry that I complained (this obviously a work culture problem).
@AceOfHearts<3 I really like your suggestion about communicating why you need the task to be done, I do that now but not as detailed- it's usually "I'm doing a medpass!" so maybe that will help.
I always thank my CNAs at the end of the shift, and always try to help if I have downtime (LOL I rarely get a lunch break!). I went back to school when I was older to become a nurse because I wanted to help people, and I believe a big part of that is being kind and treating people fairly, patients and coworkers. I need to be able to delegate appropriately and effectively to deliver good patient care. I was just replying to this post but advice is always welcome!
ArmyRntoMD, BSN, RN
314 Posts
I bribed my CNAs. Buy them a star bucks or lunch once in a great while and it’ll amaze you at how much they help out. Was definitely worth the small amount of investment capital. My day went smooth when I had those CNAs working for me.