Managers, Nurses and Delegation: Who Has Authority?

Nurses General Nursing

Updated:   Published

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 am completely floored that any of these managers help out with any type of patient care. In the clinic setting, this wouldn't happen. They come to the unit, ask someone if they need help, then expect another nurse or MA (besides them) to do it. Often times, they wouldn't know or remember how to perform the skill.

Something that irks me is when I see lazy staff complaining that they're so busy they need help (while surfing on facebook, Yahoo news, etc). Those of us who aren't squeaky wheels and do our jobs get asked to help them. When I have to stay late to teach a patient, they aren't asking me if I need help!

Why do the complainers get all of the sympathy???

On 2/4/2021 at 10:30 PM, 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!  

I would much prefer to give the enema and have my supervisor deal with an angry patient. Sadly, I get help with none of it. 

On 2/2/2021 at 7:01 PM, SilverBells said:

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.  

I think it was brave of you to post this and you have received excellent feedback which you should take on board. I haven't read your previous posts so I don't know if the other posters are right. 

I do sense insecurity about your roles which based on your replies here translates into timid body language which experienced nurses can sense. 

Personally, doing the physical tasks is the easier option. It's procedural, quick and rewarding. If you are on someone else's floor, I would suggest you pitch in as needed. You don't want to get on the wrong side of the more experienced nurses because they know people. 

Whenever I've been pulled, I do as I am told and hopefully go back quickly to where I am comfortable. Nurses eat their young and entitled. 

I still think you are brave and it's commendable for seeking advice. Good luck with the future. 

2 Votes
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
On 2/8/2021 at 8:23 AM, hppygr8ful said:

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.

Exactly this. I joke that the staff are my "patients"

2 Votes
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
3 hours ago, 2BS Nurse said:

I am completely floored that any of these managers help out with any type of patient care. In the clinic setting, this wouldn't happen. They come to the unit, ask someone if they need help, then expect another nurse or MA (besides them) to do it. Often times, they wouldn't know or remember how to perform the skill.

Oh, but in the clinic setting, it DOES happen, if you have a good manager. I happily room patients, turn over exam rooms, and field triage calls.

5 Votes

I also think you need to be aware that on every unit there's a unique undercurrent of politics, dynamics and methods of doing things worked out by the regular staff over a period of time, that you won't be privy to. You have to respect that. They might not even be aware of it themselves but it does exist from previous interactions, good and bad with each other. 

If you are in the office or around the nurse's station, you might inadvertently be drawn in and say and do the wrong thing. 

It's always safer on the floor doing things that we were trained to do and requires little effort or thought. Until you get to know their particulars well, get stuck in and get out, would be my advice. 

1 Votes
On 2/13/2021 at 12:29 PM, klone said:

Oh, but in the clinic setting, it DOES happen, if you have a good manager. I happily room patients, turn over exam rooms, and field triage calls.

SERIOUSLY??? I have never seen this happen! We are expected to help, but that expectation it's not led by example.

On 2/13/2021 at 12:27 PM, klone said:

Exactly this. I joke that the staff are my "patients"

I do know that you supervisors have to be counselors and therapists to your staff on a daily basis. I would love to find a drama-free nurses' station, but I really don't think it exists!

1 Votes
Specializes in Dialysis.
On 2/14/2021 at 2:28 PM, 2BS Nurse said:

SERIOUSLY??? I have never seen this happen! We are expected to help, but that expectation it's not led by example.

Then you haven't worked for very good managers. I've always done it. That way I can always say that I'm not asking anyone to do something that I can't/won't do myself

5 Votes

yes

On 2/16/2021 at 10:34 AM, Hoosier_RN said:

Then you haven't worked for very good managers. I've always done it. That way I can always say that I'm not asking anyone to do something that I can't/won't do myself

I work for a huge organization and I don't know a single outpatient supervisor who does this. It's an organizational culture.

Specializes in Rehab/Nurse Manager.

Struggling again today.  The help being asked for isn't anything I am able to give.   I probably will go home early because it appears I'm not really needed today.  The help that is needed requires energy I don't have anymore 

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