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?  

[JKL33]

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]

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]

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. 

 

[Wuzzie]

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]

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]

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.  

[JadedCPN, BSN, RN]

3 minutes ago, SilverBells said:

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.  

You are like the horrible spouse who says and agrees with all the changes that need to be only after they've been called out on it to save face, but then never actually make all the changes. Sorry, not sorry. 

[SilverBells, BSN]

56 minutes ago, Wuzzie said:

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

This makes me sad, but I also think there may be some truth to this.   I act as if I'm the only one capable of producing a thorough assessment, complete a progress note or initiate an SBAR, but that is not true and I need to get that thinking out of my head.  That way, my judgment isn't so clouded and I can focus on what is actually needed. 

[SilverBells, BSN]

3 minutes ago, JadedCPN said:

You are like the horrible spouse who says and agrees with all the changes that need to be only after they've been called out on it to save face, but then never actually make all the changes. Sorry, not sorry. 

Nah, you're right.  Hilarious analogy, unfortunately accurate at this point.  Thanks for the laugh, though (although I'm sure you didn't mean to be humorous). 

[TheMoonisMyLantern, ADN, LPN, RN]

Silverbells, I think you will be a good manager one day, you accept criticism well, are self reflective, and want to do a good job.

But I don't think you were at the bedside long enough and may have ascended the ranks too quickly. You've already forgotten what it's like to be the bedside nurse, and that's not going to be conducive to your career.

I urge you to consider a non-managerial position for a few years, then give management another whirl.

[SilverBells, BSN]

1 hour ago, JadedCPN said:

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. 

I'd be lying if I said I was thrilled by your reply, but you called me out on my 'crap' and it needed to be said.  

In regards to the enema situation, I think my explanation may have been more "believable" if I didn't already have so many threads discussing my joy for documentation/assessments.   But since I do, it's more than reasonable to assume that I avoided the enema due to the type of task it was, rather than not having time.  It's not something I'm proud of for sure; truthfully, I probably could have made the time.  It was just a situation that I was somewhat feeling guilty about and kept wondering if I'd handled it the right way by offering to do another task or delegating it to the evening supervisor.  I see that my guilty conscience was warranted.  

I know to you these are probably just words now that I've been called out and I get that.  But thank you for confirming what I, unfortunately, already knew to be true.  

[SilverBells, BSN]

48 minutes ago, TheMoonisMyLantern said:

Silverbells, I think you will be a good manager one day, you accept criticism well, are self reflective, and want to do a good job.

But I don't think you were at the bedside long enough and may have ascended the ranks too quickly. You've already forgotten what it's like to be the bedside nurse, and that's not going to be conducive to your career.

I urge you to consider a non-managerial position for a few years, then give management another whirl.

Thank you for this feedback.  I feel as if there are certain aspects of my manager position that I do well at, and that's probably why I've been able to hold it for a year and a half.  I do feel that a non-managerial role is something for me to consider as I continue to realize my lack of bedside experience and its impact on my ability to do my job properly and be the manager my coworkers are looking for.  I have the organizational/delegation/documentaiton/follow-up skills needed to be successful, but my clinical skills could use improvement.  I'm not sure that the improvement in clinical skills that I need is going to be fulfilled by continuing in my current role.