Delegating and still having to do everything myself.

  1. I'm in my last semester, and I have a few weeks to go. Specifically, I have a more shifts managing a 6 patient load. So far, I've completed 14 days. I work on a Neuro Med-Surg floor.

    My question lies in the delegation portion of the job. The team I generally work on includes me, my preceptor (RN), and an LPN. For the most part, my preceptor has been stepping back and letting me manage my patients. She of course is always right there to answer questions, provide support, or in some cases demonstrate how to handle some of the more difficult situations that arise that they DON'T teach about in lecture.

    I've found that oftentimes, most LPNs (that I've worked with) can't simply be expected to be consistent workers. One LPN in particular will more or less leave my 6 patients be as far as washing up / bed changes / etc. I realize that the majority of the nursing students they see on that floor are first level students with one patient who are required to do all that stuff. I think that is what they are used to doing. I've even been writing on the LPN's worksheets to complete the bedbaths/VS/etc and it still isn't getting done half the time (that is what my preceptor normally does). When my preceptor writes things, I've found that the LPNs will reasonably complete the work she gives them. I've even had the float walking around taking everyone else's fingersticks, then leave the fingersticker on my medcart so I can do my patients Of course, it then falls on me to make sure it gets done, and sets me back another 10 minutes depending on how many FSBs I need that day.

    It is literally impossible for me to get my meds done/assessments/charting/bed baths/etc on 6 patients in the time period I am allotted. On top of that I'm keeping up on new orders (which happen constantly), and dealing with families. I can't even get into the suremed on my own, so if I need something out of there I have to grab my preceptor and have her open it up for me (which happens roughly about a million times a day.) Specifically, I've found how easy it is to get behind. If anything unusual happens or is ordered early in the morning my entire day gets shot in the foot. I know I can't do this all myself, and I shouldn't have to, but I feel like I am not getting a whole lot of help from the support staff.

    I've brought this up with the LPN in question, and have even flat out told her, "I'm not going to be giving them bedbaths, or taking their vital signs, you need to do it! When I'm done with the charting I will help, but I need your help to get this done." It didn't really help very much.

    Obviously, in the end I am responsible for the care these patients recieve, and I am afraid that sometimes it is not as good as I would like it to be. Not that anyone on the unit or my team is ever standing around, but I would like to be able to delegate more efficiently. Obviously my status as a student nurse doesn't help, because even the LPNs won't listen to me half the time.

    In the past several clinical days I've had, I've missed so many breaks to complete work it is ridiculous. I've also had truncated lunches and all that nonsense. I realize that sometimes this will occur in my career, and I'm not complaining. However, I would like to be able to delegate things successfully enough where I can step back from my patients for 30 minutes to grab a bite to eat, and not have to worry about whether scheduled meds are going to be completed.

    I certainly admit that I do have a problem being assertive. I think I am getting better about it, but I can certainly see where not being assertive enough will lead me in the future (especially if I have to manage 10 patients with only me and an LPN!).

    Can anyone make any suggestions on how I can improve my practice in this respect? I've been reading over the management books, and there are lots of suggestions in there, but I was wondering what works for you to make sure people are doing their jobs? How does it work in your institution? Have you developed successful working relationships with the various LPNs/CNAs you work with? Or do you always have to tell them what to do all the time?
  2. Visit november17 profile page

    About november17, ASN

    Joined: Jan '04; Posts: 999; Likes: 1,019

    12 Comments

  3. by   midcom
    All I can say is that if you truly believe that "most LPNs (that I've worked with) can't simply be expected to be consistent workers" and you act that way towards them, then you deserve all you are getting from them. Good luck with your 6 patients. You're going to need it.
  4. by   caliotter3
    Probably at least half your problem is that, as a student, the people in question have the idea that you have no real authority over them. Their thought process probably also tells them that in a few days or weeks, they won't be seeing you anymore anyway. Find out from your supervisor what authority you actually have. Apprarently this was not made clear to you, nor made clear to the hosp staff at the beginning of the term. Either you have the ability to write someone up for not following directions, or you don't. You might as well learn how to write up slackers now. You certainly will need this skill at some time or other once you start a job. Good luck.
  5. by   txspadequeenRN
    i realize that you are new to this but 2 nurses should be able to handle 6 patients....to get more respect from the lvn you are working with... realize that she is a licensed nurse and don't order the people you work with around. you should get together and work on a plan for the day and them work together as a team....
  6. by   november17
    Quote from midcom
    all i can say is that if you truly believe that "most lpns (that i've worked with) can't simply be expected to be consistent workers" and you act that way towards them, then you deserve all you are getting from them. good luck with your 6 patients. you're going to need it.

    after 14 days of clinicals, working with this particular group of people, and having them consistently not do the things that they would normally do for any rn they work with, i feel justified in saying that. and no, i do not act that way. i'm a very easygoing person, not rude or snippy in the least bit, and am very respectful to everyone in clinicals. maybe i'm even too polite. but thanks for the advice!

    Quote from txspadequeen921
    i realize that you are new to this but 2 nurses should be able to handle 6 patients....to get more respect from the lvn you are working with... realize that she is a licensed nurse and don't order the people you work with around. you should get together and work on a plan for the day and them work together as a team....
    you are right, and that is why i don't understand why i'm not getting breaks etc (2 nurses...my preceptor will step in when necessary but for the most part i just do my thing).

    and good god no i don't order anyone around. i am the anti-ordering people around, which is why i asked for advice on being more assertive. maybe you missed the part when i asked the lpn for help with the bedbaths (not ordered) her, and she still didn't really help me. i will definitely try more open and better communication in the morning and working out a plan for the day.
    Last edit by november17 on Mar 29, '07
  7. by   midcom
    "even flat out told her, "I'm not going to be giving them bedbaths, or taking their vital signs, you need to do it! When I'm done with the charting I will help, but I need your help to get this done." It didn't really help very much."

    and that's not ordering.????????
  8. by   midcom
    I apoligize for the shortness of my answer & impatience. To be honest, as a LPN student I felt somewhat insulted by your characterization of LPNs as being inconsistant. You may have run into some who cannot be trusted to do what is assigned to them but that is not all of us. Do not put us all in the same box.

    You were asking advice & this is mine for you. Before giving orders think how you would want someone to talk to you. How about this "Mary, with your assistance, I am responsible for the care of these 6 patients. It's imperative that I do the meds, charting, new orders, assessments, and deal with the families. Therefore I will need you to make sure baths are done & vitals taken of all six patients. I'll help if I have time but do not count on it. These tasks need to be completed & I am counting on you to complete them."

    By putting it this way, you are explaining why she needs to do it & she realizes that you also have duties to fullfill; that you aren't just trying to foist off the "dirty" work to her. You do have authority over her even though you are a student & she a licensed nurse. If she doesn't realize this, your preceptor needs to clue her in. It sounds to me as if that may be a big part of your problem. The LPNs don't realize that you do have authority over than them.

    Remember also that a few kind words will get you so much more than orders. Don't forget to thank her for a job well done. If she gets the baths done & you didn't have to be on her to get it done, thank her for the good job, and be genuine. That may sound a bit excessive but most people are willing to go the extra mile if they feel they are appreciated.

    Good luck, and I really mean it this time.
    Dixie
  9. by   TexasPediRN
    Just a comment..

    You are still a student. So, for an LPN, a nurse, to be taking assignment/orders from a student is kind of odd to me.

    We were never allowed to delegate until we were a nurse.

    Your preceptor should be the one delegating, and you should be talking to your preceptor if you have problems or if you notice things are not getting done.

    Curious though, do you not have a CNA on your floor?? It seems to me that you are utilizing the LPN as a CNA almost.

    In a prior post it was mentioned that you should sit down with the LPN at the beginning of the shift to discuss your plans/goals for the day. You need to say " I'd like to split things up like this, can you please XXX and YYY and I will do ZZZ and XZXZ. I will help you as much as possible, and if you need help please dont hesitate to ask. " This leaves the door open for communication, and the LPN realizing that you arent going to order her around all day and that she can come talk to you if she needs to.

    EX)

    Bed A needs to get out of bed to the commode for the first time today. The LPN should be aware of this, but either you or the LPN should assist the patient (Whoever is available)

    Bed B needs to be turned q 2 hours - the LPN can turn q 4 hours as can you. This way you are alternating the turns, and the RN can go in and assess the pt q 4 hours. Also, you have the LPN going in every other hour and making sure the pt is doing ok, and you arent overloading the LPN with work.

    You are a team, and you need to work together. However, you cant expect the LPN to do all of your vitals and bedbaths and answer call bells while you chart/do meds. Just be a team and leave the doors open for communication and I think you will do fine.

    Its all in the way you delegate, and it does take a while to learn how to delegate properly without insulting someone. If the task doesnt get done, ask nicely why it hasnt been completed yet. Perhaps bed C didnt get a bath b/c bed D required 2 bed baths and numerous trips to the BR and kept the LPN very busy.

    Good luck in your nursing career.

    -Meghan
  10. by   midcom
    I may be wrong but if I am, so is my clinical instructor or this situation is different. I am a LPN student & during my last rotation, my classmates & I weren't busy while meals were being distributed to the residents of the LTC facility we were working at so we started delivering trays. A couple of the CNAs, whose job this normally is, sat down & started chatting, watching us do their normal duties.Since we weren't needed elsewhere we didn't mind helping but felt like we were being taken advantage of. Our instructor told us that we did have the authority, as LPN students, to tell them to pitch in & help us. She said that being students did not mean we were at the bottom of the totem pole but actualy above the CNA but below everyone else. I suspect that is also the case with the OP, if she checked. She probably does have the authority to delegate to the LPN. How else is she supposed to learn to delegate if she can't do it?
    Dixie
  11. by   LeesieBug
    Hang in there. When we were precepting during our senior year, they talked a lot in our leadership class about delegation...how we should be practicing this in the clinical setting. The general consensus amongst us was, "Yeah, right". Being a student is NOT conducive to successful delegation, for the most part. The goal, in my opinion, is to get PRACTICE and not worry so much about how effective you are.

    Yes, it sure as heck makes life more difficult as a student if team members aren't willing to pitch in. I would be taking that up with your preceptor, NOT
    the LPNs you are working with. She would be the one to give you advice on handling the situation, knowing her co-workers.

    Be prepared to have similar issues when you start your new nursing job, depending on who you are working with. Some of your team members will need to get to know and respect you before they jump in and help you out without you having to hunt them down and ask. Just be professional, tactful, and do things in turn to help THEM out when you can.... I have found that to be most effective in earning respect and encouraging team work.

    Good luck!
    Last edit by LeesieBug on Mar 30, '07
  12. by   Ariesbsn
    Just so you know, it isn't most LPNs, it is the ones you are working with. There are also just as many unreliable RNs, CNAs and students.
  13. by   ibmaryann
    As a student our instructor told the nursing staff what part of the care we were responsible for. She would say we are doing total care, or not doing the FSB, or doing PO meds. As a student we were never in the position to delegate. I was not told to not do it but we were never in a position to. I have relayed messages of delegation from the patients "real" RN. Even during my preceptoring days I was not the "real" RN. Now that I am the "real" RN I am faced with having to delegate. I am having a problem telling CLPN's to do things that have been nurses for 30 years and worked on that floor for almost that long. I still don't feel I have the authority. On all floors that I worked as a student the tasks that you are trying to delegate to the LPN were CNA jobs. The LPN and RN helped as needed but that was not their main jobs.
  14. by   psalm
    In my last semester of clinicals, with the overview of our preceptors, we RN students were to take over the team...we would delegate the assignments of vs, am care, feeding if necessary, blood sugar and insulin coverage, meds, admits from surgery, dressing changes, new orders, discharges, etc. The idea was for the student nurse to get some practice of how to run a team, with the protection of the preceptor. I had my preceptor, me and an LPN, and usually 8-9 pts. on a surgical floor. All 3 of us would take report, then I was to assign my preceptor & LPN and myself to assignments. We would regroup through out the day.

    I had my preceptor as a resource. All of us did total care for our pts, with me as the "charge" of my team making sure all was done timely, etc. It was difficult for me to delegate to others, however, I would always ask for their input during assignments. We were to assist each other when necessary...and stay communicatiing through out the shift. When I made assignments, I would give the rationale for why I was assigning pts. a, b and c to the LPN, d,e,f to me etc, to let my preceptor and LPN know where I was coming from. It is a learning process, and sometimes I would change an assign. after their imput.

    I loved my LPNs during clinicals. They role-modelled to me team work, and that we were there for the patient. I wish delegation were as "simple" now...

close