Jump to content

Managers, Nurses and Delegation: Who Has Authority?

Updated | Posted

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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?  

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

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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.  

Edited by SilverBells

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

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

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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. 

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

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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

Specializes in dialysis. Has 28 years experience.

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

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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

Specializes in Mental health, substance abuse, geriatrics, PCU. Has 14 years experience.

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, BSN, RN

Specializes in Med-surg/tele. Has 7 years experience.

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

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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. 

2 hours ago, SilverBells said:

Because of the COVID pandemic and fewer patients, I have been moved to assist on the LTC unit.  

I think this is the crux of the issue. Your new assignment is to assist on LTC. Now I have no doubt that your superior would love for you to get all of your management work done and assist on the LTC unit--but that is an issue to be clarified with your superior, not a matter of going to LTC and telling them you can't help with too much because of your meetings and management duties.

Who usually manages the LTC portion (I.e. who is your management counterpart in LTC) and what is that person doing?

Regardless, I just think this is an issue to be ironed out with your superior. Find out what you are supposed to be doing on the LTC unit and go from there. When you have this ironed out then you can let those on LTC know what you are there to help with.

I will say that whenever I've had management help in the department they always take the CN role and push the CN out to floor staff. But I think you'll do best to find out what your superior wants you to do.

MPKH, BSN, RN

Specializes in General Internal Medicine, ICU. Has 10 years experience.

Look if your role is to help the floor nurses, then you should listen to the nurses and do the tasks they requested you to do. You don’t get to cherry pick what you want to help them with. Just because you’re a manager doesn’t mean you’re magically exempt from physical tasks—you’re a nurse and able to do nursing tasks, yes?

If you had come up to me and told me you’re there to help, I’d tell you what I needed help with and expect you to actually follow through. You’re there to help me, and I determine what I’d like help with, not you. 

I’ve read your previous posts and you come off as paperwork happy and physical tasks avoidant. Usually when you offer to help, the task given to you will be a physical one as those often can’t be delayed. Charting can always be done later. You’re not gonna be more comfortable in doing physical tasks if you keep avoiding them.

Also, it is not the floor nurses’ job to understand your responsibilities as a manager. If you offer to help them out, it’s a you problem to figure out how to help them and get your own duties done. Frankly if a manager offers to help me, I don’t care about their own obligation. You offer to help me so I’m going to take you up on the offer; your own responsibilities have no bearing on me. 

 

 

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

23 minutes ago, JKL33 said:

I think this is the crux of the issue. Your new assignment is to assist on LTC. Now I have no doubt that your superior would love for you to get all of your management work done and assist on the LTC unit--but that is an issue to be clarified with your superior, not a matter of going to LTC and telling them you can't help with too much because of your meetings and management duties.

Who usually manages the LTC portion (I.e. who is your management counterpart in LTC) and what is that person doing?

Regardless, I just think this is an issue to be ironed out with your superior. Find out what you are supposed to be doing on the LTC unit and go from there. When you have this ironed out then you can let those on LTC know what you are there to help with.

I will say that whenever I've had management help in the department they always take the CN role and push the CN out to floor staff. But I think you'll do best to find out what your superior wants you to do.

I agree that the expectations need to be clarified.  My superiors were actually pretty vague when they stated I would be moved down to LTC as a support person.  The nurses down there seem to think that they now have a second nurse down there, yet I get called numerous times if I'm not at the morning meeting on time or any other meetings, such as Care Conferences. 

Prior to this, the LTC unit was actually split between me and my co-manager in regards to management duties.  We each were responsible for half of patients.  Now that there is only a need for one Rehab unit, they are keeping my co-manager down on her same unit and moving me to LTC.   With fewer manager duties to take care of on this unit, I think it probably does need to be clarified what all I should be helping with so everyone is on the same page. 

 

44 minutes ago, SilverBells said:

The more I think about it, the more it seems my confidence in my documentation/assessment skills is actually a hindrance.  

There’s an old saying “pride goeth before a fall” and I think you are walking on thin ice right now. 

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

1 hour ago, SilverBells said:

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. 

Honestly reading most of your posts on your multiple threads at this point makes me roll my eyes harder than I thought was physically possibly and I am so thankful that I don't encounter managers like this in real life that often.

Your replies are B.S., there's no sugar coating that. You either want people to think, or want to convince yourself, that you are the good guy and the victim here who is trying to do the right thing. No, you didn't think you were doing the right thing by allowing her to do the enema and you do the charting - you selfishly did the task that you like to do and went out of your way to avoid the task that you don't like to do, as evidenced by all your previous other posts stating you like paperwork and dislike hands on care.

It is insulting to us as readers for you to try to spin it another way, so I am absolutely sure it is even more insulting to your nurses. You aren't fooling anyone at this point and its almost disgraceful. Then for you to take this to a whole other level and starting questions who has authority?!  If you didn't have time or couldn't help your nurse then you should have never said you could help in the first place. 

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

On 2/2/2021 at 5:54 PM, MPKH said:

Look if your role is to help the floor nurses, then you should listen to the nurses and do the tasks they requested you to do. You don’t get to cherry pick what you want to help them with. Just because you’re a manager doesn’t mean you’re magically exempt from physical tasks—you’re a nurse and able to do nursing tasks, yes?

If you had come up to me and told me you’re there to help, I’d tell you what I needed help with and expect you to actually follow through. You’re there to help me, and I determine what I’d like help with, not you. 

I’ve read your previous posts and you come off as paperwork happy and physical tasks avoidant. Usually when you offer to help, the task given to you will be a physical one as those often can’t be delayed. Charting can always be done later. You’re not gonna be more comfortable in doing physical tasks if you keep avoiding them.

Also, it is not the floor nurses’ job to understand your responsibilities as a manager. If you offer to help them out, it’s a you problem to figure out how to help them and get your own duties done. Frankly if a manager offers to help me, I don’t care about their own obligation. You offer to help me so I’m going to take you up on the offer; your own responsibilities have no bearing on me. 

All fair enough.  I've been thrust into this role of being a support nurse for the LTC nurse, I did not actually volunteer or sign up to help out extra on this unit, nor did I indicate to the nurses working the floor that I would be there as a second nurse.  BUT that is besides the point.  I am there on that unit, so therefore, need to make things work.  

As a good manager, listening to those around me is of upmost importance.  I clearly am not listening to what my staff actually needs, especially if, when they ask me to do something, I counter-offer with something different.  If they wanted me to do this other task I'm offering to help with, they would have asked for it.  I am sure it hasn't gone unnoticed that I only volunteer to help with certain tasks, regardless of if it is what the unit or the patients actually need(s) at the time.  I need to do a better job of listening to what my staff actually needs, not just snagging the tasks that seem to suit only my own interests. 

And yes, I am a nurse (obviously) so more than capable of doing all of the physical cares.  It's almost as if I have forgotten what nursing is about by becoming a manger.  This needs to change.  I need to step back from some of the less critical tasks that, for some reason, I tend to gravitate towards and focus on what's actually important; interacting with and providing cares to patients.  And if that means I don't write as many SBARs or someone else does the daily nursing charting or the admissions, then so be it.