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?  

[Davey Do]

7 minutes ago, SilverBells said:

LovingLife123: 

I would agree that your post was not an attack.  It was very straightforward and to the point, but you didn't say anything that wasn't true.   It was clear that you didn't care for how the situation was handled, and that is fine.  When you create threads online, you open yourself up to feedback, positive or negative.   Sometimes the feedback is not what you want to hear, but need to hear.  Other times, there will simply be a difference of opinion and that's okay.   I think in this situation it was important for me to realize that I was in the wrong, especially since my colleague's request was not unreasonable. 

 

4 hours ago, Davey Do said:

Let's agree to disagree.

 

[SilverBells, BSN]

As a side note, some of you may remember that I sometimes drink between 6-15 Diet Pepsi's a day.  Today I only had 1 and found that I was less irritable 

[SmilingBluEyes]

You need to take better care of yourself. Your diet and your mental health.

You have clear anxiety and eat/drink way too much junk. You're headed for a physical and/or mental breakdown.

Eat better, sleep well and quit obessessing.  That's my advice. Everyone else covered the rest so I won't beat a dead horse.

[SilverBells, BSN]

As a side note, it was almost a relief to let someone else to do the admission for the change.  It was nice to not have to work over 16 hours or stay until midnight or later.   It's possible that all of those late nights are a reason they don't want me as active in admissions for the time being...they don't necessarily want me there that late.  Regardless, things will work out and there is plenty of other things to do on the LTC unit that don't require me to stay there for hours on end. 

[SmilingBluEyes]

I appreciate your propensity for self-reflection. I think that is an asset on your part. PLEASE, please take better care of yourself.

[hppygr8ful, ASN, RN, EMT-I]

On 2/2/2021 at 2:04 PM, SilverBells said:

.......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 of I won't get my own job done.   

There really is no line to draw here. If you were at risk for completion you should not have volunteered yourself. This isn’t a delegation question. You asked if you could help the nurse in question told you what they needed help with and you declined.The general tone of your posts suggest you feel bedside tasks are beneath you. Also I would be careful about “Finishing other people’s charting as all the areas you say you can still require an in person. Face to face assessment. Keep going what you Are doing and you risk being named in lawsuit when something happens. There is absolutely nothing worse than being deposed. I’ve been there done that though not for fraudulent charting.  

[PsychNurse24, BSN, RN]

On 2/2/2021 at 3:21 PM, 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. 

I agree with you. And you stated the nurse was five minutes away from shift change and had not done the enema?  She should’ve asked for help earlier or helped with the patient’s physical needs first and then stayed later to do charting.

 It also makes sense to Do what you’re good at. When things are crazy busy and you are excellent at charting/documentation, then I would gladly have accepted your help in that area.  You stated you were on the floor all day, so I believe that you could’ve done a lot of those assessments that you mentioned.  Don’t be so hard on yourself!  

[TheMoonisMyLantern, ADN, LPN, RN]

23 minutes ago, PsychNurse24 said:

I agree with you. And you stated the nurse was five minutes away from shift change and had not done the enema?  She should’ve asked for help earlier or helped with the patient’s physical needs first and then stayed later to do charting.

 It also makes sense to Do what you’re good at. When things are crazy busy and you are excellent at charting/documentation, then I would gladly have accepted your help in that area.  You stated you were on the floor all day, so I believe that you could’ve done a lot of those assessments that you mentioned.  Don’t be so hard on yourself!  

Surely you've had shifts where right up to the last minute you had patient care tasks that needed to be done. Even with the best prioritizing and time management skills, it happens. In LTC which is where the OP works, it is incredibly common to be running right up until the end, and asking for help in this area of nursing can be a joke because either everyone is drowning or the person you ask for help is only willing to do things which don't really help that person out. And as far as staying over to do charting, that gets old after a while. 

There are nurses that would be helped out most by picking up the charting especially if they have difficulty navigating the EMR, so in that case that could be helpful. But patient care always takes priority over charting and that's usually what is more helpful. Depending on the the assessments I wouldn't want another nurse charting those for me on patients I was assigned.

[InHisImage, BSN]

On 2/2/2021 at 5:04 PM, SilverBells said:

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. 

What others have been saying, and what the bottom line is, is that if you have time at all to help then you do whatever task needs doing, regardless of what it is, and the person that is asking for help dictates what she needs help with.  But if you don’t have time to help because you have other duties, then you don’t say that you can help with one thing but not another.  You can’t have it both ways.

[Nurse Mentor Nancy, MSN, RN, NP]

"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. "

Good question.  Been there done that.  I will answer with another question.  How much education in management or leadership, Silver Bells, did you get prior to or after you took this position?  If you are like most new nurse managers, your answer will be: very little or none.  If you not have learned the skills you need to become a successful manager, no amount of clinical experience will help you.  

That being said, do not despair.  The answers you gave to some of the comments, which might cause others to get defensive or run for the mountains, show that you are self reflective and willing to learn.

You sensed there was a better way of handling the situation.  You are right.  An authentic leader would develop the kind of relationship with her team member to work out a solution acceptable to them both.  Send me a private message for more details.

[vintagegal, BSN, DNP, RN, NP]

Patient care always comes first. I work LTC and I can tell you I’d much rather do direct patient care than worthless meetings and time consuming paperwork. It’s the administrative part of my job I like least. I think the issue is when you feel taken advantage of. You start to notice after a while which staff members will milk you for all your worth and other staff who seem pretty self sufficient but require help in a pinch. The balance is noticing whether you are truly needed vs when you’re not. But the problem is, you have to do the care if they can’t or won’t, because not following the physician order (such as missing an enema administration) can fall on your license as the DON. Especially if someone can prove you had the time and ability to do a care and you didn’t. 

[SilverBells, BSN]

Update:  I had another shift where I was more active on the floor, assisting with two emergencies and one semi-emergency, along with assisting another nurse with obtaining an I&O urine sample.   I took care of sending both patients to the hospital so the floor nurses could focus on other duties along with helping with transfers in an attempt to prevent falls.  Unfortunately, I don't feel too good about myself at this point, because ideally the emergent situations should have never happened.