New nurse needs advice

OhioCCRN, MSN, NP · Sep 10, 2011

As a new nurse myself, i have had to tread the fine line of delegation.....

its not easy, please remember that ultimately, YOU are in charge of the pt's outcome and it is YOUR license that they will come after....

In a similar situation w/ an STNA, I made sure i let her know that it was not an option to get the vital signs.. I needed them in 10 minutes.

Put your foot down and don't let yourself be pushed around. and remember to always be respectful in whatever you say...

Hope this helps.

Esme12, ASN, BSN, RN · Sep 10, 2011

So...I am a BRAND NEW nurse. I've been in my hospital for 2 months and with my preceptor for maybe a month of it. I have been taking two patients of course with the help of my preceptor when I need it. Now, my problem is that I am still learning to organize myself and delegate. Well, one day I had given some IV blood pressure meds to a patient and was going to lunch soon so I asked my PCA to "please do a blood pressure on so and so when you can." She was chatting at the nurses station to the monitor tech for awhile so I didn't think it was too much to ask. Her exact reply was "The blood pressure machine is in the room." I was so taken off guard. I just said "okay, thanks, ill just do it later." I went to deal with my other patient who needed the bedside commode and when i was done the PCA had done it anyway and gave me what the pressure was. But it just was so frustrating. I am so new and trying to understand my place and all. Was i out of line to ask for a blood pressure. I don't think its beyond me to do it either. This patient had blood pressures in the 200s so I had been taking them all day too. Not to mention earlier in the day I had asked this same PCA to HELP me take this patient (who was VERY obese) to the bathroom. She said "oh..she doesn't need help." I don't know how to deal with this as there is only one PCA that has responded to me this way. So my question is....how have you dealt with situations like this as a new nurse?
Thanks.

Which patient needed the licensed nurse? :idea:

First of all.....welcome to nursing. It is a difficult job and even though you take a test that tells you you can do it.....you still have much to learn. I don't think it is out of line for you to ask the aide to do the B/P. I usually will say something like...."Hey, Sally....can you please do me a big favor and take Mrs. So n So's B/P....I need to go and do xyz in room 314..thank you!" This way they know you are not just going to sit down and take a break. Not all nurses are considerate of their non licensed personnel assisting them and treat them poorly. I have always made sure that the non licensed personnel helping me that I do not ask them to do anything I myself would not do and that I am not above wiping a few butts and will help them if I can.

However, the point you made that you had just given an IV med on a patient exhibiting a blood pressure high enough to require IV intervention, you should be the one monitoring that patient.... whether or not it's time for lunch. Giving meds IV requires close monitoring by a RN so that if there are any reactions that need to be immediately attended to, like a sudden drop in B/P, you are there to give the required intervention. You gave the med you should be the one monitoring the patient......especially in light of the fact you have only 2 patients.

This is where it sounds like a homework assignment answer (now you know why they gave homework). :smokin:

The appropriate delegation/prioritization would be for you to take the B/P on the patient you just gave the IV med to and ask the aide to escort the patient to the bathroom. One patient should have the licensed personnel and the other doesn't.

I would tell the aide..."Hey I am need to re-check the pressure on Mrs. So n So....I just gave her some IV meds for her B/P that's been up all day......can you please help 314 to the bathroom......thanks!".

I hope this is helpful.....

mandrews · Sep 10, 2011

I would have asked her to please help 314 with the commode and took care of the HTN patient myself. You are delegating so she is not qualified to help with bloodpressure meds but she can help someone with a bsc. Praise her when she does a great job and make her see she is a valuable person on the team.

I know that taking vitals and bsc are a large part of their job description but unfortunately they see alot of nurses who are not willing to help in those areas. That being said if she is disrespectful or things get worse it may need to be addressed.

I<3H2O, BSN, RN · Sep 10, 2011

I have to fully agree with Esme here. Excellent advice. In the event that you truly need the PCA to assist you or to get a set of VS for you, I advise you to not be passive aggressive about it. Say something like, "PCA, I am going to need you to get a set of vital signs on room 312 at 1500 because they have XYZ going on. I am going to be giving IV BP meds in room 314 which requires pretty close monitoring." Don't do the "hey if you don't mind" or "when you get a few minutes" type of comments. That gives them the idea that you don't care when or if it is done. It also gives them the opportunity to say, "oh at 1500 I was going to be assisting Nurse Z with a dressing change." or something else...

IDK what kind of IV BP meds you are giving but I agree with what Esme said about the RN taking the VS. When I am giving IV BP meds, I take the BP q15min x4. If the first 3 are ok, I may ask the CNA to grab the last set but otherwise, it's all me!

ETA: if you EVER ask a PCA to go do something for you just so you can go to lunch, they will probably think you are lazy, bossy, have RNitis, etc.

mmm cdiff · Sep 10, 2011

Review the 5 Rights of Delegation at https://www.ncsbn.org/323.htm#The_Five_Rights_of_Delegation, particularly "Right direction and communication". No offense, but "please do this when you can" implies that it's not something that needs urgent attention, and sets you up for comments like "do it yourself then".

dizzyray822 · Sep 10, 2011

I completely agree with you all. Honestly it was a complicated day for me. My preceptor gives me the most complicated pts so I get the most out of my orientation which is good for me. There is much more to the story in regards to both pts. The one going to the bathroom was a COPD pt that ignited her O2 on fire at home and suffered smoke inhalation and was constantly SOB. The high blood pressure pt I had taken care of the day before and she was going into renal failure and refusing dialysis. She was on IV labetalol q 3 hrs and still maintaining BPs in the 170/90s. I wasn't too concerned about a drop in BP with her but was concerned about the smoke inhalation pt. In the mean time my preceptor was downstairs dealing with a pt she had discharged and wouldn't leave. Just my first day with a lot going on and my first time asking for help from this person. I definitely have much to learn. I love what I'm doing but am still trying to get more comfortable in prioritizing and being organized and delegating.

Esme12, ASN, BSN, RN · Sep 10, 2011

I completely agree with you all. Honestly it was a complicated day for me. My preceptor gives me the most complicated pts so I get the most out of my orientation which is good for me. There is much more to the story in regards to both pts. The one going to the bathroom was a COPD pt that ignited her O2 on fire at home and suffered smoke inhalation and was constantly SOB. The high blood pressure pt I had taken care of the day before and she was going into renal failure and refusing dialysis. She was on IV labetalol q 3 hrs and still maintaining BPs in the 170/90s. I wasn't too concerned about a drop in BP with her but was concerned about the smoke inhalation pt. In the mean time my preceptor was downstairs dealing with a pt she had discharged and wouldn't leave. Just my first day with a lot going on and my first time asking for help from this person. I definitely have much to learn. I love what I'm doing but am still trying to get more comfortable in prioritizing and being organized and delegating.

:hug: Hey....you did a good job we just showed you how to do it better the next time....live and learn.

Hospice Nurse LPN, BSN, RN · Sep 10, 2011

Part of the CNA's job is to get routine vitals, but if I'm giving a med dependent on VS, I always get my own vitals. It's me giving the med and I want to be certain.

Kooky Korky, BSN, RN · Sep 10, 2011

If I had given IV BP Rx, I would do the VS myself at the exact time I wanted them done. This was improper delegation, IMO.

Others have stated and I agree - don't say anything like "pretty please with a cherry on top". you're at work,the aide is at work. Tell her what you want her to do and when. Telling her VS were needed "when she could " was wrong.

Get over, right now, worrying about hurting the aides' itty bitty itsy bitsy achey breaky feelings. They are at work to work. I just feel like cursing roundly because so many of you nurses are so afraid to have them work. :mad: :mad:

I would have asked her why she was telling me that the BP machine was in the pt's room. It was a completely irrelevant answer.

She might be lazy, she might enjoy challenging you to see how much you will let her walk on you. Put her in her place right now or you'll be coming back here in a few months telling how she did you dirty and how you think you should quit. Ever hear of writing people up for insubordination? No, don't do it yet but keep it in the back of your mind as part of your orificenal for dealing with this disrespectful pup.

dizzyray822 · Sep 18, 2011

So....continuation of my troubles with this PCA....

Yesterday it was 12:00 and I looked for the BGL of one of my patients with Accuchecks every 6 hours and it wasn't charted yet. So I called her to see if it was done but just wasn't charted. When I asked her she says "oh, I didn't know he had Accuchecks. Well, I'm on break so you'll have to do it." I obviously did it because I needed it but I'm dreading everyday I have to work with her because I know what'll be like. When shes there none of my patients are ever cleaned, they never have water, their sheets are a mess, and she has no problem passing the buck. I complained to my preceptor that it's an obvious problem with her. She says she has the same issues and I should go to our manager about it. However, I feel way too new to start complaining already. Any advice?

Esme12, ASN, BSN, RN · Sep 19, 2011

:heartbeat

So....continuation of my troubles with this PCA....
Yesterday it was 12:00 and I looked for the BGL of one of my patients with Accuchecks every 6 hours and it wasn't charted yet. So I called her to see if it was done but just wasn't charted. When I asked her she says "oh, I didn't know he had Accuchecks. Well, I'm on break so you'll have to do it." I obviously did it because I needed it but I'm dreading everyday I have to work with her because I know what'll be like. When shes there none of my patients are ever cleaned, they never have water, their sheets are a mess, and she has no problem passing the buck. I complained to my preceptor that it's an obvious problem with her. She says she has the same issues and I should go to our manager about it. However, I feel way too new to start complaining already. Any advice?

Ok...time for fun is over. You need to make an appointment with your manager and tell her, in a nice way....no whining, what has been going on and ask for her advice on what to do. Tell your manager that because you are new you don't know how to handle this but it's becoming problematic and patient care is suffering. Make sure you say that you want advice to better patient care and that you are seeking her advice. It will be less whiney and your preceptor should step up for you.....unless this PCA is one of those "I've been here forever and I know better" types and gets away with murder. They can be very difficult to deal with and very passive aggressive.

https://www.ncsbn.org/323.htm#The_Five_Rights_of_Delegation great link someone posted earlier about delegation...........

I'd go to your manager......and ask for help.

https://www.ncsbn.org/323.htm#The_Five_Rights_of_Delegation