How do you handle delegating to PCA's?

[missdeevah, NP]

i am curious to know how other nurses out there handle delegating tasks to pca's. i'm always very polite in asking (not commanding). i would say, "ms pca, would you please put some scd's on pt in room 123?" i do try to do tasks like these when i can. but if i have to 2 things that both need to be done, one of which can only be done by a nurse, then i will delegate the other task to a pca. i do help patients up to the bsc or bathroom, help with repositioning in bed, get them ice, water, snacks, etc.

my shift starts @ 1900. there's a pca a few days ago whom i asked to put scd's on a pt. she looks at me and says nothing (she has this habit of not responding when asked to do tasks by nurses). almost 2 hrs later, around 2245 nothing has been done regarding the scd's. at this point i had already gotten 1 admission, had a transfer that had arrived right before shift change, and i had been informed that i was getting another admission, though the charge would help me with doing the actual admission paperwork. so, later i find the cna sitting @ the nurses' station as i'm running around trying to take care of my 5 patients. i remind the cna, as she looks like she is getting ready to leave. at this point, i'm on my way to do my admission paperwork on the first admission. she walks away, then turns around, throws her hands in the air and says loudly, "you don't know how to do it?" then walks away. later, after she has left, i find that she has put foot pumps on the patient. the week before there had been a big issue with a pt that had scd's on, that had not been ordered, and due to the pt's illness, scd's were actually a contra-indication. so i wondered whether she was trying to set me up, or had this been an honest mistake?

what kind of tasks do you delegate? how would you have handled the above situation? i would like to point out that the pca in question is quite a bit older than i am, has been at the job for several years, and the day before was making a big scene @ the nurses' station about how nurses have yelled at her and how people like running to the manager to complain about her.

[Black Nightingale]

Writing an incident report and talking to management about her would be the best route. Don't approach the PCA yourself, leave that to management. When speaking to management about her, explain how the situation could've been detrimental. Management needs to make it clear to this PCA that she has a job to do, and if she doesn't like her job, she can find another one. In my experience, some PCAs especially older ones, can often be ultra-defensive and resistant to direction from younger RNs. PCAs need to know that they are expected to take direction well, and fulfill their duties as expected. As RNs we should remain mindful of our interpersonal communication skills. As long as you delegate responsibly and respectfully, no PCA should give you any lipservice or resistance!

[pers]

Sounds like you handled it really well with regards to asking, the only thing I would have done differently is ask for clarification that she heard me. Just smile and say her name, I like to get acknowledgment from people to make sure they heard what I ask. Sometimes people will be talking to me and I don't realize it so I'm not paying attention, I may look their direction because I happen to look that way but that doesn't mean I was paying attention to what they were saying. It sounds like she intentionally ignored you but by getting verbal clarification from her you eliminate the possibility for missed communication on your end.

Personally, if she had told me "you don't know how to do it?" I would have responded that my knowing how to do her job doesn't mean I'm supposed to do it so she doesn't have to. And if she did it wrong, the next time we worked together I would have pulled her aside and explained that she was asked to do x but in fact did y, so apparently she didn't know how to do what I was asking and then explain it to her and make sure she understands. I'd also send a note to the NM and let her know what happened.

I don't generally have a lot of problems with PCAs. Occassionally when I ask someone to go do something they'll do the "why don't you?" bit but I just reply that I'd be happy to if they will go do *insert nursing only task* for me and that takes care of things. Another issue I have run into is when they need help and then neglect to tell me that they won't be doing something that is normally one of their tasks (chemstrips, weights, whatever) so I don't know that I need to take care of it. I haven't had this problem in a while as I made it very clear that it is their responsibility to either do their job or tell me specifically (not tell someone else to let me know) that they won't be doing it.

[happy2learn]

Well, I think she needs to be written up. Her attitude needs to be documented. She needs to be told to leave the attitude at the door. She is there to work. If she can't do that and be respectful, then I'm sure there are plenty of other people who would love her job.... I would!

I can never find the PCA's in my hospital. Never. But thankfully about half of the nurse's are nice (like you.)

[roser13, ASN, RN]

I feel for you. When I first started (age the age of 40, no less), I struggled with the terrible CNA attitudes in that particular facility, and how to delegate. The only thing I can tell you for certain is that if you try to be too awfully nice, it will backfire on you. You will not gain their respect, nor will they believe that you mean it when you make a serious request.

I agree with the above advice. Whatever "incident report" exists in your facility, you need to document plainly and without emotion that you requested that Ms. CNA perform such and such a task @ such and such time. And that X hours later, you observed Ms. CNA sitting without obvious occupation, without having complied with your request. I would also quote the little come-back that she threw at you about don't you know how to do it.

You might also (completely seriously) request an education session for Ms. CNA so that in the future she can better understand how to perform her job....SCD's vs. foot pumps, for example.

[malem]

I am a PCA and I can totally sympathize with you. I am 50 years old and I have been a PCA for the past five years and I am just as frustrated by those that always seem to be sitting down at the nurses station. During a 12 hour shift I rarely get to sit down, even for a second. It is very nice when nurses will pitch in when I am super busy and take patients to the bathroom, pull them up in bed, etc. But I have also seen aides give a lot of attitude to nurses ( and vice versa).

I think it helps to give a specific time that you need the task done by. " Ms. PCA, could you please take patient #1 to the bathroom before 11 a.m so that I can -------do whatever-----. I'll check back with you about 5 of 11. Thanks." I have seen this work with PCA's that are always trying to get out of their job.

[msn10]

Delegation varies by state. Some RN's can delegate foley insertion while other states can be very strict. This is a HUGE issue in national nursing organizations because of litigation and increased numbers of CNAs, UAP's, or PCAs.

You, as an RN are accountable for every task you delegate. For your responsibility in delegation go to

https://www.ncsbn.org/fiverights.pdf.

It is the 5 Rights of Delegation created by the National Council of State Boards of Nursing. If your CNA does not follow your instruction based on those 5 steps, you must wright her up or implement whatever other disciplinary action is necessary. By law it is your responsibility to ensure pt. safety.

You may even want to post a copy of the 5 Rights in the nurse's station or break room. It is the standard and it helps nurses when talking to their supervisor regarding such issues. I was co-author on a delegation module for preceptors in my own state and I was surprised at the things I didn't know.

Also, look up your own state's nursing practice act to make sure you are delegating what you are suppose to. Like I said it varies by state. Good luck.

[msn10]

Also, one more helpful hint. You can not delegate tasks in the nursing process (assessment, planning, diagnosis, or evaluation) except implementation. For instance, you cannot ask your CNA to assess the patient "Can you check on Mrs. Smith and tell me how her breathing is?" But you can say "Mrs. Smith's breathing has stabilized so can you get her up in her chair with her 02?"

Sorry for all the info but this subject is near and dear to me.

[roser13, ASN, RN]

Also, one more helpful hint. You can not delegate tasks in the nursing process (assessment, planning, diagnosis, or evaluation) except implementation. For instance, you cannot ask your CNA to assess the patient "Can you check on Mrs. Smith and tell me how her breathing is?" But you can say "Mrs. Smith's breathing has stabilized so can you get her up in her chair with her 02?"

Sorry for all the info but this subject is near and dear to me.

msn10:

I'm not sure that your 2 posts are relevant to the question.

The OP asked the PCA to place a pair of SCD's on the patient. Under pretty much anyone's definition of "tasks that can be delegated," that request would qualify.

[GGT1]

I'll probably get burned for this but... I have worked as a PCT throughout nursing school and have gained some valuable insight- IMO. It really is a very hard job... not mentally... but physically. For example, I am often put on a hall with 12 rooms, 4 nurses, and 1 tech (ME). It would seem to me that with 4 nurses it would be easier for all...but really what happens is now I have 4 needy (yes I said it) needy nurses asking me to... get accu-checks, blood pressure, foley, urine sample, clean a pt up, get them a lunch tray, take them to the restroom, go to the lab, wound care, positioning, put pt on cardiac monitor... and many of these tasks are Q2-4 H... for 12 patients.

So, on the other hand... I do see many techs avoiding work, chit-chating, playing the disappearing act, and generally having an attitude if asked to do something. But just think... how many other nurses have asked her to do something. How many bed-baths has she given, vitals has she taken, linen change.

Now I do understand that you have many tasks that can not be delegated (meds, assessment, intake, etc.) and I can agree on people needing attitude adjustments... but maybe when you are sitting and chit-chatting, ask a Tech if they need some help.

Let the roast begin:)

[jerenemarie]

I always believed in giving someone the benefit of the doubt if they did not follow my instructions to begin with, but if it happened again...then I would always talk to them myself (with another nurse present!) with written documentation that would go in their file. I always tried to make teaching a part of any task I delegated to nursing assistants so they would know why something needed to be done, for example "Please check so & so's temperature so we can see if the tylenol I gave her earlier bought it down", etc. We are not there to make friends but if you treat nursing assistants with respect they usually will respect you too. If they see nurses out there answering lights & assisting patients instead of sitting at the desk that goes a long way towards respect too...but they also need to know if you are busy with other nursing duties you cannot always help out this way!

Thanks!

[msn10]

The OP asked the PCA to place a pair of SCD's on the patient. Under pretty much anyone's definition of "tasks that can be delegated," that request would qualify.

Not true. The 5 rights talk about how to delegate appropriately so there is no confusion.

Has the PCA done that task before? Is she trained properly or able to do it on that floor? Does she have a specific time when it needs to be completed by and how will she report she has finished the task to the RN?

These are all questions that an RN is accountable for.

Missdeevah also asked "What kind of tasks do you delegate? How would you have handled the above situation?"

The link I referenced talked about how she should have delegated the SCD's. For instance, she could have said "Sue, I need you to place the SCD's on Mrs. Smith by 3:00. Please let me know when you put them on. Do you have any questions?"

Nurse practice acts also talk about when a PCA is deficient in his or her task completion how nurses can approach the situation. How and what you delegate is not a simple question, it varies considerably and I was answering her questions with resources that are approved by licensing boards so she receives the correct info to protect her patients and her license. Sometimes posts reflect advice from experience or opinion and that can be dangerous.