Rn delegation to LPN

chevyv, BSN, RN · Feb 21, 2009

Although this isn't a rn situation I have to tell you all what a fellow ns told me the other night...

We have a total of 2 pts as nursing students (last semester). We are responsible for everything (yea, finally on our own, sort of). Well, for the first 4 weeks half of us are at bedside and the other half are are at various other sites (icu, ed, hospice) for a shift. During the 4th week we are all together as sort of a transition type week.

The student I had to work with told me she plans on delegating as much as possible to the lpn. This is med surg in hospital and we have (did I mention) 2 pts! Thats all, just 2. Now, I'm also a lpn in ltc and would love to have just 2 pts, but I have 28. I know in the hospital the lpn has between 5-8 pts. I respectfully explained to the other student (who has no experience with pt other than clinicals) that the lpn would have their own pts to care for and delegating would probably interfere with the students own assessments. I was getting nowhere and she stuck to her plan on delegating as much as possible out.

Here's what I didn't tell her. I didn't tell her that I was a cna for 15 yrs and the new nurse that came on and felt the urge to delegate everything so she could sit and chat ended up with cna's who would be so busy with other pateints that the newbie would be fending for herself most of the day. I also didn't tell her that she would be shooting herself in the foot by delegating things that she should more than be able to handle (2 pts!) to other staff who are surely busy with their own pts.

I just had to shake my head and shut my mouth. It would do no good. I hope she gets it before she passes her boards and becomes the nurse from hell!

truern · Feb 21, 2009

Although this isn't a rn situation I have to tell you all what a fellow ns told me the other night...
We have a total of 2 pts as nursing students (last semester). We are responsible for everything (yea, finally on our own, sort of). Well, for the first 4 weeks half of us are at bedside and the other half are are at various other sites (icu, ed, hospice) for a shift. During the 4th week we are all together as sort of a transition type week.
The student I had to work with told me she plans on delegating as much as possible to the lpn. This is med surg in hospital and we have (did I mention) 2 pts! Thats all, just 2. Now, I'm also a lpn in ltc and would love to have just 2 pts, but I have 28. I know in the hospital the lpn has between 5-8 pts. I respectfully explained to the other student (who has no experience with pt other than clinicals) that the lpn would have their own pts to care for and delegating would probably interfere with the students own assessments. I was getting nowhere and she stuck to her plan on delegating as much as possible out.
Here's what I didn't tell her. I didn't tell her that I was a cna for 15 yrs and the new nurse that came on and felt the urge to delegate everything so she could sit and chat ended up with cna's who would be so busy with other pateints that the newbie would be fending for herself most of the day. I also didn't tell her that she would be shooting herself in the foot by delegating things that she should more than be able to handle (2 pts!) to other staff who are surely busy with their own pts.
I just had to shake my head and shut my mouth. It would do no good. I hope she gets it before she passes her boards and becomes the nurse from hell!

Wouldn't have worked with my clinical instructor!! We could delegate certain tasks to the CNAs, but only if we *really* couldn't get to them ourselves. Delegation is a responsibility not to be taken lightly, nor abused!! I have a feeling the LPNs will put her in her place pronto.

moseshopper · Feb 22, 2009

She has a rude awaking coming when she starts working. She will find that you have to pull your own weight at least thats true in a hospital. Anyway just because you are a rn there still someone above you to answer to, and thats true in anything.

Lovely_RN, MSN · Feb 23, 2009

Sorry for the long post but as a former CNA and a current LPN this strikes a nerve with me.

Your friends a real jerk and she is going to get her rear handed to her!

First of all there is no way any self respecting LPN is going to allow a student to delegate to them!

In a team nursing scenario the RN team leader delegates certain tasks to the LPN. For example the RN may do the admissions, assessments and administer IV meds because it's within their scope (depending on state of residence). The LPN may be assigned to PO meds and treatments while the CNAs are assigned to routine care, bed changes etc.

This differs from a primary nursing situation where the charge nurse makes the assignments and each nurse has her own patient load. In that case do you think random RNs are delegating their tasks to the LPNs when that LPN has their own patient load? It doesn't work like that and it's part of the reason why RNs complain about working with LPNs in primary care nursing it's because they can't delegate to the LPNs but if the LPN has to do something out of their scope the RN has to do it.

In any event I cannot see a situation where a nurse whether they are an RN or LPN is going to take crap from a student. She will be lucky if the CNAs even put up with her nonsense because I know a lot of CNAs consider themselves to be a cut above nursing students. Futhermore, many CNAs already feel like they are pushed around enough and they just aren't going to take it from a student. I would be very surprised if the charge nurse or nurse manager allows students to behave the way your classmate is planning to. When I go to clinicals and we aren't doing something for our assigned patients we are expected to help out on the floor. We make beds, do fingersticks, pass out meal trays etc. We don't go around with snotty attitudes making MORE work for the staff.

txspadequeenRN, BSN, RN · Feb 24, 2009

lol...right..i bet that is going to go over well...

the student i had to work with told me she plans on delegating as much as possible to the lpn.

DaFreak71 · Mar 16, 2009

Just playing devils advocate here, but MAYBE the nursing student wanted to get her feet wet by:

a. Reinforcing in her mind what tasks could be delegated.

b. Practicing her communication skills with other members of the team.

It's sad that some people would abuse their authority by making someones job more hectic than it needed to be. I hope this isn't the case, but I've seen it in action too. :banghead:

This whole "she's gonna get her butt handed to her" mindset is not what nursing needs. It's a collaboration and if someone is overstepping their bounds, I would hope that before someone went into "retribution mode" that a constructive conversation would take place either between the LPN/CNA and RN, or include the nursing supervisor. This isn't high school (or it isn't supposed to be). :nurse:

BabyLady, BSN, RN · Mar 30, 2009

In our nursing program, we are in our last semester, and yes, and as part of our program, we were told to start delegating certain assignments to CNA's or the LPN.

The charge nurse goes over this with everyone in report. So they understand that any assignment that we delegate is to be followed just like if it was a staff RN.

As students, we are there to learn...we are not there to make their shift easier so they can "take the day off".

The first day of clinicals this year, when we went on the floor, the CNA's were "yeah, students!"....the charge nurse said, "Don't get too excited...they are second year."

The purpose of this is so we can get used to delegating. So far, I haven't seen the reason to delegate anything to an LPN because I still need practice in pulling meds, knowing what I'm giving, giving injections, hanging IV's, starting IV's, etc.

However, if Mrs. Smith vomits on herself, needs a bedpan, help with showering, etc...IF there is a CNA to delegate it to...I delegate it...if there is not, I gladly do it myself.

It's not about passing off a "dirty" job...it's just that once you have helped with toileting, bedmaking, and cleaning up messes...been there, done that, bought the t-shirt...these are things that I KNOW how to do...but this is our last semester of practice under instructor supervision to really learn how to do what we will be doing most of the time....and we need all the practice we can get before we graduate.

NurseCubanitaRN2b, BSN, RN · Apr 7, 2009

I'm a CNA right now and I have RN's delegating to me all the time. Usually, I have no problem with it, but what I do have a problem with is when those RN's that do hunt me down to ask me to change a patient. For example I was floated to the Maternity unit the other day and the RN had to find me (I was on break by the way) to ask me if I could change a peripad because it looked prety disgusting. I politely told her that I was on break but that I would get to it as soon as I was back. She said that the peripad looked pretty gross and thanked me. In my mind I was thinking. If it's that gross, why didn't YOU CHANGE IT? You took the time to check her bleeding, how hard is it for you to change it while you're at it?

luvmy3babies · Apr 8, 2009

This is an response to LatinaVNstudentRN2b. That would have burned me up inside the RN telling you to change a peripad because its too gross. NO one is too good to change peripads, give bedpans etc.. I am a LPN and I have seen LPN and RNs stop and go out of their way to look for a CNA to answer a call light or change a bedpan. When they are not busy at all just chatting at the nurses station with other nurses. And what kills me the most a CNA maybe in the room feeding a pt or caring for a pt at the same time. The time a nurse went and hunted for the CNA they could have done it themselves. It is a team effort and no one in this buisness is better than others just because the level of education is different. You can learn from anyone and that includes a CNA. Heck, I had some RNs who did not know their job and had their BSN .And when they asked me to do something not for one minute I hesitated to help. I do not know where it went wrong that a certain nurse is better than the other. I thought we were all in this together. When I become a RN I will certainly not forget where I came from .Like some nurses often do.

eric909 · Dec 28, 2009

Although this isn't a rn situation I have to tell you all what a fellow ns told me the other night...
We have a total of 2 pts as nursing students (last semester). We are responsible for everything (yea, finally on our own, sort of). Well, for the first 4 weeks half of us are at bedside and the other half are are at various other sites (icu, ed, hospice) for a shift. During the 4th week we are all together as sort of a transition type week.
The student I had to work with told me she plans on delegating as much as possible to the lpn. This is med surg in hospital and we have (did I mention) 2 pts! Thats all, just 2. Now, I'm also a lpn in ltc and would love to have just 2 pts, but I have 28. I know in the hospital the lpn has between 5-8 pts. I respectfully explained to the other student (who has no experience with pt other than clinicals) that the lpn would have their own pts to care for and delegating would probably interfere with the students own assessments. I was getting nowhere and she stuck to her plan on delegating as much as possible out.
Here's what I didn't tell her. I didn't tell her that I was a cna for 15 yrs and the new nurse that came on and felt the urge to delegate everything so she could sit and chat ended up with cna's who would be so busy with other pateints that the newbie would be fending for herself most of the day. I also didn't tell her that she would be shooting herself in the foot by delegating things that she should more than be able to handle (2 pts!) to other staff who are surely busy with their own pts.
I just had to shake my head and shut my mouth. It would do no good. I hope she gets it before she passes her boards and becomes the nurse from hell!

Sorry this is funny as an LPN I'm not taking orders from any unlicensed nursing student. I am also an RN student and if you can't do total care on two med surg patients you need to choose a different profession.