Managers, Nurses and Delegation: Who Has Authority?

[SilverBells, BSN]

So wanted to brainstorm through a situation that came up recently.   At my facility, I am normally a nurse manager for a rehab unit.   Because of the COVID pandemic and fewer patients, I have been moved to assist on the LTC unit.  

The other day, when I went down there, one of the nurses listed off various things they were needing help with down on the unit: med pass, feeding people, vital signs, obtaining daily weights, etc.  I explained to her that I could help out with some things, but that I would still be attending to other duties, such as attending morning meetings and completing telehealth provider visits.  She seemed to understand at that time. 

However, about a day later, a patient had requested an enema in the afternoon. I passed this along to the nurse, who stated she would get to it if she had time.  About 5 minutes towards shift change, she mentioned to me that she had never gotten to it, and that the oncoming replacement was a TMA, who isn't supposed to be giving enemas.  In other words, I believe she was implying that I should be the one to do it.   

I gave her a couple of options: I could help finish up with some of her charting so she would have time, or she could pass it along to the evening supervisor.  I explained that I already had admission orders to review from the other unit.  I believe she ended up passing along the task to the evening supervisor.  From my knowledge, the enema was never  given because the patient ended up having a couple of large bowel movements.  

What I am wondering is who had authority in this situation.  The nurse seemed like she wanted to delegate certain tasks to me, but, as a manager, I would think it would be me that determines who completes which tasks, not her.  I guess I'm not sure what should have been done since we each had different opinions on who should do what.  The patient ended up being fine, but just wondering about future situations like this.  

Who does the delegation? The manager or the nurse?  

[LovingLife123]

I would think if you came down to help me, I would tell you what I needed help with.  I don’t understand what the big deal is.  You seem to have taken offense to the fact that a nurse, who needed help, told you exactly what she needed help with.  This literally has zero to do with you being a manager.  It has to do with somebody needing a little help.  

[SilverBells, BSN]

13 minutes ago, LovingLife123 said:

I would think if you came down to help me, I would tell you what I needed help with.  I don’t understand what the big deal is.  You seem to have taken offense to the fact that a nurse, who needed help, told you exactly what she needed help with.  This literally has zero to do with you being a manager.  It has to do with somebody needing a little help.  

Respectfully, I do understand that this person needed help.   In no way, shape, or form was I offended that she needed assistance with a few things.  With that said, I did give her a few options, given my other responsibilities, in order to assist her.  The tricky thing is, floor nurses have a hard time understanding what managers are being tasked with if they have never had a management role.  This isn't their fault, but some of them don't seem to realize we aren't there to do necessarily everything for them, either.  It's a challenging balance between wanting to assist coworkers while also making sure we aren't taking on too many additional tasks ourselves.   The thing is, if we say yes to everyone's request, then our own jobs don't get done, and that can cause issues as well.  

[Jedrnurse, BSN, RN]

You offered to take the time to do some of her charting, but couldn't give an enema?

I'm perplexed- I've given more than a few of them over the years and they really don't take that long to do. (Even with the follow-up to monitor results.)

[SilverBells, BSN]

14 minutes ago, Jedrnurse said:

You offered to take the time to do some of her charting, but couldn't give an enema?

I'm perplexed- I've given more than a few of them over the years and they really don't take that long to do. (Even with the follow-up to monitor results.)

Again, I had other duties/responsibilities at the time.  It actually would have been to her advantage to accept my offer to assist with the charting.  She often reports that she stays too long after her shift and it is during this time that she is charting.  Honestly, she could have left sooner if she would have taken my offer, but chose to stay for 2 hours doing so anyway. 

[Wuzzie]

1 hour ago, SilverBells said:

I could help finish up with some of her charting so she would have time,

This doesn’t make sense. How can you finish her charting?

[SilverBells, BSN]

Just now, Wuzzie said:

This doesn’t make sense. How can you finish her charting?

There are assessments/daily progress notes that any nurse can do.  Things such as Skilled Nursing Data Collections, Day 1-4 Admission Assessments, Oral Data Collections, Pain Data Collections, Morse Fall Scales, Braden Scales, Bowel and Bladder Assessments, and AIMS are just a few of the assessments that anyone is able to complete, so it is not just the floor nurse's charting.  Also, a lot of the charting has to do with monitoring for side effects, change in condition, etc.  With me being down on the unit all day, I'm able to observe and document on these issues.  Anyone with knowledge on any of these concerns, especially if they have observed the residents themselves, is welcome to complete the charting.

[Hoosier_RN, MSN]

SilverBells,

You keep posting the same things over and over, worded differently. You only like doing paperwork/management duties.  Unfortunately,  when you offer help, you don't get to pick and choose. I was a DON, and did many things that I didn't like so that the staff nurses could chart. Some days, I didn't make it to meetings, patient care is priority, and what the facility is reimbursed for. I couldn't chart for them, they did the assessment, not me, that's unethical and illegal. You're starting to come off as uppity and unwilling to do what you consider to be beneath you. That's a big no-no in attitude for progression in a career. In fact, I think this may be your issue. I'm sure your superiors have seen it, or at least heard about it.

What if, due to covid or other situation, tomorrow you weren't needed in a management position, but needed to staff the floor? Would you quit? Throw a fit? Again, you need to review your attitude. In the facilities that I worked/managed, you'd have been demoted long ago, while you worked on your attitude

[SilverBells, BSN]

It seems that maybe I was in the wrong in this situation, which is entirely possible.  I'm not always right.  I guess my question is, though, where does one draw the line between their own responsibilities and complying with someone else's requests?  As I mentioned previously, if I say yes to someone every time they need help, there's a chance I won't get my own job done.   Also, again, floor nurses who haven't worked in a management position don't necessarily understand how many directions I am pulled in or what my other responsibilities might be.  Without that experience, they can't possibly know.  With that said, I am unsure if they are the ones who should be telling me what I should be assisting with? I don't know, and maybe I read this person wrong, but it just seemed as if she wanted to dictate what she did and did not need help with and what I should and should not be doing, which to me seems like role reversal.  Again, like I said, I might be wrong...and based on some of the responses I am getting, it seems like I was.   And in her defense, she didn't specifically ask me to do the enema, but the way she worded things made it seem like she was implying I should do it.  Perhaps she didn't directly ask because she was afraid of what my response might be.  I hope that is not the case, but if it is, then that's not a good thing either. 

I guess my main thing is: Where do you draw the line? It's important to be helpful while also not overworking yourself and failing to meet your own responsibilities.  If I start saying yes to every request, my own job won't be completed.  But obviously saying no to everything isn't the answer either. 

[TheMoonisMyLantern, ADN, LPN, RN]

What has a higher priority, documentation of routine assessments or attending to a physical need of a patient? What you thought would be helpful to the nurse wasn't helpful to them, they needed then enema administered, why couldn't you do that?

Your staff do no care how hard your job is, nor should they, management's job is to support their employees, you want to cherry pick what tasks you do to "help" and then are shocked when people aren't feigning over you in gratitude.

[NightNerd, MSN, RN]

I hear what you're saying about needing to make sure your tasks are done - but if my manager comes to me asking what I need help with and implies they have time to do it, I hope they'll help with what I actually do need. I would also feel very uneasy about them doing my documenting, as I've been with the patient all day and can most accurately attest to most of the items you mentioned for that shift.

I think it would have been nice to give the enema, since that's what the nurse determined she needed help with and you did offer up your time to assist. It's not so much a matter of who should delegate to whom as it is you trusting your staff to know what they need help with and being supportive, while also being realistic about what you can do. Ten minutes is ten minutes, no matter what task it is, so if that's the amount of time you have to give your nurse, be ready to use it however they need help.

My manager is really great about this stuff. She'll check in and if I'm the least bit overwhelmed, she'll ask what I need to do and will pick a task - usually the most annoying one - to take off my plate. It is such a morale booster, and it means that when she isn't in a position to help as much on the floor, I know she is dealing with other stuff. It's great to have that mutual trust.

[SilverBells, BSN]

5 minutes ago, TheMoonisMyLantern said:

What has a higher priority, documentation of routine assessments or attending to a physical need of a patient? What you thought would be helpful to the nurse wasn't helpful to them, they needed then enema administered, why couldn't you do that?

Your staff do no care how hard your job is, nor should they, management's job is to support their employees, you want to cherry pick what tasks you do to "help" and then are shocked when people aren't feigning over you in gratitude.

I guess my thinking was that the nurse could attend to the physical request of the patient and I would help her out with the charting, since she was concerned about not getting that done.  By no means am I trying to state that the patient's need didn't need to be met.  Obviously, there is disagreement as to who should have met it. 

Thing is, in my opinion, I thought I was being helpful, but it appears not to be.   Unfortunately, I can't hide that I view my assessments/documentation to be more complete than hers, and that possibly influenced which task I was willing to help out with.  The more I think about it, the more it seems my confidence in my documentation/assessment skills is actually a hindrance.  

I don't know, maybe it's a good thing that I am being asked to help out on a unit where management duties aren't as relevant.  I'm wondering if I have been in my position too long and my judgment is being clouded.   Or maybe I was promoted too soon in my career (I've said and thought this before) so that being asked to do former job duties causes me anxiety.  I don't know.  I guess I'm trying to find a way to keep my current position while adjust to the different needs that currently need to be met.