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?
Silver bells, I think it is a disservice if they are pushing you to your limits. It sounds as though maybe your taken advantage of. Which sadly, many LTC facilities will hire new RNs as DONs to take the fall if something happens. Watch you back my friend! I empathize with you.
Silver bells, I think it is a disservice if they are pushing you to your limits. It sounds as though maybe your taken advantage of. Which sadly, many LTC facilities will hire new RNs as DONs to take the fall if something happens. Watch you back my friend! I empathize with you.
Thanks. I'm a unit manager, not a DON, but feel stretched to my limit. Both the nurses I supervise and my superiors expect me to do everything for them. I'm expected to complete daily provider visits, follow up on SBARS, handle all emergencies, assist with admissions and discharges, follow up on abnormal lab tests/results, correct medication errors, complete weekly wound rounds, attend morning meetings and Care Conferences that extend 1 hour each, fill in on the medication cart for low staffing, deal with call ins and so on and so forth. Now our social worker is expecting the unit managers to deal with all grievances within 1 business day, so now I have to dedicate 30+ minutes every day following up on patient complaints, no matter how frivolous. For example, I had to spend 30 minutes listening to a resident complain about the color of the plastic silverware served during meals. Thus, my days are always at least 12 hours long, but usually longer
Not to mention daily phone calls from family members who expect you to listen to them rant and rave for an unlimited amount of time. If you don't, they report you, and administration/social work almost always sides with them
Specializes in Mental health, substance abuse, geriatrics, PCU.
7 hours ago, SilverBells said:
Thanks. I'm a unit manager, not a DON, but feel stretched to my limit. Both the nurses I supervise and my superiors expect me to do everything for them. I'm expected to complete daily provider visits, follow up on SBARS, handle all emergencies, assist with admissions and discharges, follow up on abnormal lab tests/results, correct medication errors, complete weekly wound rounds, attend morning meetings and Care Conferences that extend 1 hour each, fill in on the medication cart for low staffing, deal with call ins and so on and so forth. Now our social worker is expecting the unit managers to deal with all grievances within 1 business day, so now I have to dedicate 30+ minutes every day following up on patient complaints, no matter how frivolous. For example, I had to spend 30 minutes listening to a resident complain about the color of the plastic silverware served during meals. Thus, my days are always at least 12 hours long, but usually longer
I have to be honest, everything you listed is what is expected of our unit managers as well. It's a lot of work and not easy. Some of the managers here don't do everything expected of them and get by with it but their units are poorly run as a result.
I think you're experiencing a learning curve going from staff nurse to a manager. With time you'll be able to better manage your days, but if it's too much then do what you have to do.
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.
I have to be honest, everything you listed is what is expected of our unit managers as well. It's a lot of work and not easy. Some of the managers here don't do everything expected of them and get by with it but their units are poorly run as a result.
I think you're experiencing a learning curve going from staff nurse to a manager. With time you'll be able to better manage your days, but if it's too much then do what you have to do.
Thanks for the feedback. Realistically, I am curious as to how many of your managers actually complete what is expected of them in a timely manner? I am wondering since my colleague and co-manager feels the same way I do--we are run ragged and everyone else seems to feel their time is more valuable than ours. She's actually taken 7 days off work in this last month due to the stress.
Specializes in Mental health, substance abuse, geriatrics, PCU.
31 minutes ago, SilverBells said:
Thanks for the feedback. Realistically, I am curious as to how many of your managers actually complete what is expected of them in a timely manner? I am wondering since my colleague and co-manager feels the same way I do--we are run ragged and everyone else seems to feel their time is more valuable than ours. She's actually taken 7 days off work in this last month due to the stress.
The two managers I really admire, start with getting report from the staff nurses regarding any issues, while the staff nurses are doing meds the managers are review labs, wonky vitals, family phone calls, meetings, rounding with the provider to get resident's needs addressed. They get it done, some of their reports wind up late but there's a little leeway for "forgiveness" with that due to the fact that resident care needs come first. I realize that every facility is different and may not be as lenient.
I think once you know the residents and the staff really well that it may make the job easier for you.
Specializes in Psych, Addictions, SOL (Student of Life).
35 minutes ago, SilverBells said:
Thanks for the feedback. Realistically, I am curious as to how many of your managers actually complete what is expected of them in a timely manner? I am wondering since my colleague and co-manager feels the same way I do--we are run ragged and everyone else seems to feel their time is more valuable than ours. She's actually taken 7 days off work in this last month due to the stress.
I don't know a manager yet especially in LTC or Psych who doesn't C/O about the workload. I was a manager briefly and hated it yest the few extra pennies were nice but what I was told by a manager I highly respected is that when you move from the floor your focus will change to one in which you are more focussed on the needs of the facility rather than the patient. All I know is that if a manger offered to do my charting I would politely decline. I have been asked to and refused to chart assessments I didn't do which is a fast way to the unemployment line and maybe a ticket before the BON as well.
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.
I am going on a limb here! I Don't kill me! LOL!
I have been on both ends!
Tricky bar to balance! Been there, done that.
You do have to have a balance. Be ready to help if you offer, no matter how unpleasant it may feel to you. It builds confidence of your team. I set limits, teach the needy ones to problem solve and make sure they have what they need especially supplies and working machines. Most of the time my door is open and my team sees me problem solving. However they all know to call me for a true emergency and if they are backed up like crazy and are drowning. They hardly ever call me on my cell phone although we have each others numbers stored.
On the other hand you do have nurses who would like to test the waters and see how much they can get you to do and like to delegate. I had one that tested me for 6 months (she made my life miserable!) before she gave up and told me "I thought that when you were nice and had our backs that you were faking it but you have not changed-----!" She turned into my biggest help and now calls me her mentor! I don't like gossip and if one of my staff brings something to me, I stop them there and ask to bring in the second one so that we can get it in the open as it is unhealthy! Most of them suddenly have no further issues. Just remain fair and polite no matter how much you feel triggered on the inside.
What I would do is go to that nurse maybe an hour and half before her shift ends and ask her, how things are and what's priority. If the oncoming staff cannot do the enema, then it does go on the priority list. Out of the 5 things she lists, find something you can reasonably do to help. When she sees that you don't mind , you may either gain her trust or she may try again thinking you are the enema queen---!
I would draw the line if I genuinely don't have time to do it and not offer. I would circle at mid shift just to check in with the staff even if I can't help. Follow your instinct. It tends to lead you to the right thing to do. All luck!
You didn’t want to help the nurse with the enema because you didn’t want to. Just admit it. Well the truth is, nobody really wants to give anyone an enema but if it needs to be done it needs to be done. Patient care takes priority over whatever important management tasks you claim to have needed to do. It only would have taken a few minutes of your time.
Charting is not something that can be delegated. The primary RN must assess the patient and chart the assessment. She/he can then delegate tasks. Assessments/charting cannot be delegated. You cannot do this for the primary RN. You asked the RN what was needed and they asked you to do an enema. It’s not a big deal. Do it. If you don’t know how, say so and ask to be taught, learn the skill so that next time you can help out with a simple task. It’s okay to say “it’s been awhile”, or I need a refresher!” RNs love to teach! We will show you how so we know you got it next time so we don’t have to!
we have CNLs nursing on our covid units now and many have not been at the bedside in years. I am so grateful they are showing up in scrubs taking patients now!! we need those dedicated, loving, nurses, at the bedside! They have forgotten some skills and time management but they are here and learning and helping! And when this is over they will return to their rolls and have a whole new appreciation for what we do!
so don’t give up, don’t hold it against your nurses...if you need a skill refresher ask for it! An enema takes 10 minutes. It’s not taking away from your duties...you just seem scared to do it. It’s no big deal! Ask for help!
vintagegal, BSN, DNP, RN, NP
341 Posts
Silver bells, I think it is a disservice if they are pushing you to your limits. It sounds as though maybe your taken advantage of. Which sadly, many LTC facilities will hire new RNs as DONs to take the fall if something happens. Watch you back my friend! I empathize with you.