Managers, Nurses and Delegation: Who Has Authority?

[SilverBells]

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?  

[SilverBells, BSN]

On 2/23/2021 at 6:42 AM, klone said:

I'm going to be honest and blunt - they gave you those tasks because they don't view you as a competent manager. 

It turns out I misunderstood the assignment that I had been given.  They didn't necessarily expect me to give residents showers myself, they were only looking for someone to ensure that aides were offering the residents or a shower because the number of residents who supposedly had refused a shower or bath over the weekend was suspiciously high.  Regardless, the thought of giving someone a shower or bed bath shouldn't have provoked the level of panic and anxiety it did. 

 

 I've claimed in my previous posts that when I see something that needs to be completed, I do it, but am dubious about the truthfulness of that remark.   Frankly, I've identified many tasks that needed to be done but did not actually perform due to their nature.  Whether or not I've responded to a need at hand has historically depended on what that need is, which I acknowledge isn't acceptable.   If the Executive Director and Director of Nursing can step out of their offices to help feed residents or deliver meals to their rooms, then surely I can assist with non-administrative tasks as well.  They were observed doing so multiple times this week and set a good example for others to emulate.  I must say that I felt a tinge of guilt related to my past actions after watching them.  

Therefore, as I stated in my above post, I did try and do a better job this week addressing any and all tasks that were needed in an attempt to follow my leaders' example.  There were times that sometimes there wasn't an actual task to complete, but rather a resident who simply wanted to be listened to, so I gave them my time.  Regardless, I found it less stressful to let go of the desire to hog all of the administrative tasks and be more of a well-rounded coworker. 

[SilverBells, BSN]

One example of my attempts to make myself a better coworker/manager was actually agreeing to assist with a request I wasn't confident that I was the right person for.   A new admission had arrived to our facility and was so weak that she needed multiple people to help her into a car after leaving the hospital.   One of my coworkers asked if I could assist.  I was reluctant because I wasn't sure I was the right person for a difficult transfer, but agreed.  Between me and two other coworkers, we did get this person safely transferred from the car into a wheelchair.  Once we got her into the facility, she wanted to lay down, so we took her back to her room.  She was too weak to stand again, so we had to use a Hoyer lift.  Using mechanical lifts and placing slings has always made me a bit uneasy, but I took the initiative to hook up the sling anyways and obviously stayed until we got her into bed.  Surprisingly, I found I knew more than I thought.  

Anyway, this post isn't to receive a round of applause since these actions should be expected from me on a daily basis.  It does go to show that I do have the ability to not be a horrible coworker though. 

[hppygr8ful, ASN, RN, EMT-I]

1 hour ago, SilverBells said:

After Monday, I spent the rest of the week responding to the tasks that were actually needed.  I did not complete any admission assessments, but otherwise had a nice balance of both administrative and nursing tasks.  If I offered to help with something and was told my assistance wasn't needed, I simply found something else that was equally important to complete.  Sometimes this simply meant answering a call light, obtaining a blood sugar, or assisting with a transfer.  Other times I was asked to follow up on a patient change in condition, write an SBAR, or clarify an order.  Funnily enough, by focusing on the tasks I was actually asked for assistance with and not attempting to "hog" any particular assignment, I was able to work more reasonable hours this week (think 8-10 hours each day, rather than 16-20).  I thought I loved completing admission assessments and reviewing discharge summaries but my week was surprisingly more enjoyable because I didn't try to take over those tasks. 

I love it when a plan comes together!