When Delegation is Unsuccessful

allnurses Guide · Mar 15, 2022

This is simple - Write the offenders up. In most long term scenarios a patient must receive the first dose of an ordered antibiotic within 4 hours of it being ordered. If the fall was related to an active untreated infection then that becomes a sentinel event and needs to be reported to state agencies. You did nothing wrong by delegating this task. The only thing I can see is that instead of choosing one person to delegate to you chose six which may have created confusion about who was required to follow-up. Also did you document the delegation in writing in the patient record? IF not you never actually delegated the task.

Hppy

Davey Do · Mar 15, 2022

12 hours ago, SilverBells said:

I'm far from being perfect

'Pfft!", he said.

12 hours ago, SilverBells said:

Have you ever delegated something to a colleague only to have it not work out?

Jeezo Pete, yes!

My 12-hour weekend option RN mate who worked Days to my MNs sucked canal water! I could tell you some stories that would make your SilverBells sound out the alarm!

I learned to have some sort of fail-safe system in place if important enough. However, my dear SilverBells, I did not deal with the volume of patients and responsibilities that you do.

We do the best we can and let go of it.

**NICU Guy, BSN, RN** · Mar 15, 2022

14 hours ago, SilverBells said:

I feel guilty about having last Friday off, because I know the order would have been taken care of had I been there. I'm far from being perfect, but it's just not something I would have missed. I'm frustrated that I asked for help with ONE thing, an easy task, and I didn't get help from anyone.

I have to say that the above instance is a prime example of why I do not delegate much.

Write them up. You were not delegating a task to them, you were asking them to do their job. You were handing off responsibility to another nurse. You are not responsible for actions that should have been taken after you transferred responsibility to another nurse.

14 hours ago, SilverBells said:

I have to say that the above instance is a prime example of why I do not delegate much. I try not to take too many days off because of things like this. I've always had trust issues, and things like this just make it worse.

This is an issue that needs to be addressed by upper management. It is not your duty to work 24/7 to prevent these issues from happening because your colleagues are incompetent.

macawake, MSN · Mar 15, 2022

On 3/14/2022 at 9:38 PM, SilverBells said:

Have you ever delegated something to a colleague only to have it not work out?

I have a recent example of this. Last Thursday, we collected a urine sample on a resident. I found out that afternoon that I would be off on Friday, so I asked six colleagues to please follow up on the results, knowing that the weekend was coming and provider coverage would be limited. I came back this morning to find out that an antibiotic had been ordered Friday evening, but it had never been entered. None of the 6 individuals I had asked had followed up on this. In the meantime, the resident had an unwitnessed fall over the weekend and had a quick ER visit. He returned with no injuries, but I can't help but wonder if his untreated UTI contributed to the fall. I feel guilty about having last Friday off, because I know the order would have been taken care of had I been there. I'm far from being perfect, but it's just not something I would have missed. I'm frustrated that I asked for help with ONE thing, an easy task, and I didn't get help from anyone.

Has anyone else ever experienced this? How did you address your concerns? Did it impact your ability or willingness to delegate in the future?

I have to say that the above instance is a prime example of why I do not delegate much. I try not to take too many days off because of things like this. I've always had trust issues, and things like this just make it worse.

Healthcare is a 24/7 gig. Following up lab results and making sure that patients or residents get the correct medication is the responsibility of every shift. You shouldn’t have to delegate to someone to check lab results and orders. That’s the responsibility of each and every shift. The nurse assigned to a patient on any given shift has that responsibility.

You should also have a system in place that makes sure that this works even if an individual healthcare professional has a day or a month off, or calls in sick. How do you get the lab results? Don’t you have an electronic chart? How did the provider order the antibiotic? Scribble it down on a piece of papyrus and hide it in the catacombs beneath the LTC?

As I said, this isn’t a task that should have to be delegated. Someone needs to review how your organization is structured from a patient safety and organizational robustness perspective. But since you chose to delegate this… why on earth did you delegate one task to SIX people? Diffusion of responsibility is seldom a good idea.

Remind us again SilverBells… What makes you stay at this facility? The amount of drama and problems you post about really is quite impressive…

LPN Retired, LPN · Mar 17, 2022

Your facility has 24 HR coverage with licensed nurses, yes?

NO JOKES OR PUNS ALLOWED, BSN, RN · Mar 18, 2022

Don't write them up. You're a fool if you think you can impact six people's employer/employee relations and come out the winner. (I don't think you're dumb enough to do that, but then again, people suggested it, which boggles the mind.)

Rather than the "hard power" of delegation, try soft power, like persuasion. People do not love being told what to do by their equals. People love feeling like they're doing you a favor.

"Will you follow up on Frank's UA?" is benign and a normal request, but people resent it, forget it, or whatever.

"I'm really worried about Frank. When you get those results this weekend, can you just text me a ?to let me know what's up?" People are more likely to act when you do all the boring work of humanizing for them.

JBMmom, MSN, NP · Mar 18, 2022

On 3/14/2022 at 9:38 PM, SilverBells said:

I have to say that the above instance is a prime example of why I do not delegate much. I try not to take too many days off because of things like this. I've always had trust issues, and things like this just make it worse.

You have to live your life and make work a part of it, not the center of it. You are entitled to your time off and you're NOT responsible for what happens when you're not there. Since you can't be there 24 hours, there must be a system in place for new orders to be entered, correct? If you're the only one with responsibility for this, there's a serious problem with how your place of business works.

It's very unfortunate that this happened, and I would agree that a fall may have occurred because it wasn't addressed in a timely fashion. Is it your fault? No. And as someone else pointed out, potentially asking so many people to follow up may have led them to believe that someone else was going to do it. Who gets the new orders? Did someone speak with a provider? If so, they should have followed up and entered the order. To me delegating is asking someone to do something when you're there but have to prioritize your own activities. Whoever was there when the results came in was supposed to DO THEIR JOB and start that order. You didn't have to delegate it because you weren't there so you weren't responsible. This is no way falls on you.

Editorial Team / Admin · Mar 18, 2022

15 hours ago, NO JOKES OR PUNS ALLOWED said:

People do not love being told what to do by their equals.

SilverBells is the manager in this situation, not their equal.

mtmkjr, BSN · Mar 18, 2022

Absolutely no one is benefiting from this approach to management.

->The patient's health and safety is at risk because of care and treatment not being provided in a timely appropriate manner.

->The staff are not held accountable for inaction and they fall into a pattern of dependence on management to do what they should be doing. They are unengaged and very likely unsatisfied in their work not to mention putting their licenses at risk when they do not take appropriate action in response to patient needs.

->You are frustrated, exhausted and will quickly burn out if you accept the burden of 24/7 direct.

I hope for the good of everyone you find a way out of this downward spiral.

NO JOKES OR PUNS ALLOWED, BSN, RN · Mar 18, 2022

37 minutes ago, Rose_Queen said:

SilverBells is the manager in this situation, not their equal.

Then why did she use the word peers over subordinate?

allnurses Guide · Mar 19, 2022

20 hours ago, NO JOKES OR PUNS ALLOWED said:

Then why did she use the word peers over subordinate?

You probably don't want to go there!

I pointed out a long time ago that while a manager can have peers the people one manages are still subordinates and not peers in the true sense of the word. Several people jumped down my throat for suggesting such a thing as if being an effective manager equals being a bully.

Hppy