When to know you're over delegating

[NerdyCandy, BSN, RN]

Hey everyone!

This is kind of a weirdly specific question, but I will provide some background. I would like to start off by saying I admire CNA's/ Nurse Techs/ PCT's (i.e. whatever nursing aides are called in your facility) and see them as an invaluable asset to the flow and functioning of the unit.

I am a new grad RN, and today was my second day on the floor with a preceptor. We were busy on the unit this afternoon, and a situation came up with one of my patients that required my immediate attention (new suicidal ideation). I got a call from another patient requesting to use the bedpan. I felt that the patient with SI needed my attention at the moment, so I approached one of our PCT's and asked if she would be willing to help patient B use the bed pan. The PCT seemed annoyed with my asking, but ultimately went to go help patient B.

Later in the day, I go in the breakroom to each lunch and that PCT, as well as another were already eating in the break room. I sat down to eat my food, and was mindlessly scrolling through my phone when one of the PCT's said something that I feel was directed at me. She said essentially that she didn't want to be a nurse because nurses don't spend enough time with their patients, and they're always asking the PCT's to do things that they don't want to do. She said it was sad that nurses don't spend more time with their patients, and that the higher up you go in the nursing profession, "the lazier you get". I pretended like I didn't hear, and just continued scrolling on my phone.

Now, this made me pause and reevaluate what I consider to be appropriate delegation. I certainly did not mean to come off as if I was asking the PCT to do something simply because I didn't want to, but now I am not sure what the appropriate way to delegate tasks is. I don't want to upset every PCT I work with when I ask them to help me with something, but I also realize that you also can't make everyone happy, and some people just like to find something to complain about.

So essentially what I am asking is, what is the secret sauce to make delegation not seem like I am just dropping tasks on the PCT that I don't want to do? Any suggestions or tips would be greatly appreciated.

[Cricket183, BSN, RN]

First, don’t second guess your delegation. It was absolutely appropriate. You didn’t ask the tech to help the patient to the bedpan out of “laziness” or because it was a task that was beneath you. You had another priority that took precedence. One that a tech could not address.

A couple of things that I have found that really help when delegating:

Always treat your techs with respect. When delegating, treat them professionally. You’re requesting their help, but you’re also requesting they do their job. Don’t apologize. Be straightforward and IF you have time, explain the prioritization behind your request so they understand you’re not just asking them to do tasks you don’t want to do. “Can you please help patient A to the bedside commode. I need to medicate Patient B for pain before PT gets here.”

You’ve only been on the floor a couple days so it might take time, but when you do have the time (on the rare occasion) be willing to jump in and help when the techs are giving your patient a bath. It’s a great time to assess skin. Or when they’re turning a patient, or feeding a patient. The PCT that said we (nurses) don’t get to spend enough time with our patients wasn’t wrong. (Although her attitude and motivation suck!). We are spread so thin, we don’t get to do the type of care many of us wish we could. Over time the techs come to realize who is willing to help out and who isn’t. They will figure out if you’re delegating because you’re busy or if you never help a patient to the bathroom or change a brief or clean a bedpan.

One last thing, appreciation goes a long way. Never forget to show it. A simple, “Hey, thanks for helping Mr C to the bathroom. It gave me a chance to chart his daily assessment.” (No I wasn’t playing a video game or surfing the internet!)

[JBMmom, MSN, NP]

This comes up throughout all areas of healthcare and you will deal with it throughout your career. You give very good reasons why you made an appropriate decision to delegate one activity because you could not delegate the other. I'm sure you didn't have the time (nor would it be appropriate) to say to the PCT, please help patient B with the bedpan because I have to deal with patient A's new onset suicidal ideation issues. There are times when you have to delegate because while you can do all activities the PCTs are responsible for, they cannot do all of your job. You don't sound like someone who would leave a patient waiting for a bedpan for no reason, there are nurses I work with that feel there are "PCT jobs" and nurse jobs. They are not very helpful in many of those activities, and ultimately that affects the patients. I've had very open discussions with PCTs at times, and you might consider following up with the PCT to give an explanation of the situation, my PCTs know that I will do ANYTHING needed for my patients, and if I'm asking them for help there's a good reason. But those relationships take time to develop. Give yourself time, creating good working relationships is a key to success, especially with your good PCTs.

[JadedCPN, BSN, RN]

I second the advice of giving your reasoning for delegation. Yes, it is "their job," but I have always found my PCTs to be more receptive if they understand that I'm asking them to do a task that I am capable of performing because I am going to be doing a task they can't do in another room. This is moreso about common courtesy and respect.

I also agree about jumping in to help the PCT when you can so that they can see that you are a team player and willing to get your hands dirty, so to speak. It has been my experience that many times PCTs have been there for years, have seen nurses come and go, they know their stuff, and just want that respect. I have no problems giving it to them.

I personally only delegate when I truly do not have the time to do something myself. I have found that because of this, my PCTs know that when I do ask them to help a pt to the bathroom or get a blood glucose level, it is because I am genuinely busy with someone else, so I never get pushback.