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Why do nurses delegate with a power trip?

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by CrzyNrsBSN CrzyNrsBSN (Member)

So I started as a CNA and worked my way up, minus LPN. I now find myself with a BSN and a blur of my days as an aide.

I recall feeling underappreciated and lower than dirt. I remember being "told" to complete tasks and not asked.

Once I became an RN, I left LTC and thought I would never look back. I am an ER nurse. As a social experiment, I decided to work PRN in a LTC facility.

Let me just say WOW! Nurses are constantly jumping down the aides throats, for EVERYTHING! Please do no say "CNAs are lazy,.worthless, uneducated and conferntational". Please do.not say that these things are not said behing the CNAs back. They are! You smile in their face and talk about their incompetence, when their backs are turned.

The techs in the ER are not micromanaged, they are trusted to complete tasks. They do EKGs, blood draws, insert IVs,.splint as well as straight cath. I have watched the techs execute CPR and save lives! Our team work is outstanding. They are part of the medical staff. Although they cannot present themselves as nurses to the patients we all refer to them as "technical nurses"

We do not have the ability to write them up, we do not have the ability to reprimand in ANY way. That is up to the ANM and NM ONLY. We educate them if they need help understanding certain tasks. In the same respect I have been educated by them as well.

They do not just do slave work,.they do valuable work and they do it proficantly. They are respected as knowledgeable co workers, not monkey workers.

I have worked in other parts of the hospital and every other type of nursing field. LTC seems to be the only place I see that. I want opinions on why this is. Also, if CNAs were called PCTs (not nursing assistance, essentially nurses B****) as well as allowing them on the job training, to have a little more responsibility, that "real" nurses see as more than just crap work (pun intended). Lastly, not allowing every LPN, RN to write them up. Do you believe.this would make for an easier, more respectful (between every title) atmosphere.

Oceanpacific

Specializes in Infection Prevention, Public Health. Has 33 years experience.

I don't look at the world in the same black and white categories. Are all CNAs abused? No. Do all RNs abuse CNAs? No. Are the ED techs working in a more expanded role than CNAs? Yes.

Congratulations on completing your RN / BSN. I think starting out as a CNA gives you some unique insights and appreciation and empathy.

Karou

Specializes in Med-Surg. Has 1 years experience.

I can tell you are really passionate about this topic. I started out as a CNA in LTC, worked at the same facility later as an LVN, and now work in a hospital as an RN.

How many LTC/NH facilities have you worked in? I ask because I have only worked at one (for four years) and I never saw that kind of attitude towards CNA's. When I was a CNA, I was always treated with respect by the nurses (LVN's, our only RN's were the DON and ADON). We worked together as a team because we had to in order to survive in that environment. LVN's did delete to me, which was always appropriate. I wasn't always asked to do things, sometimes I was told, and that was okay with me because it was always fair and something important that I was being told to do. In LTC, the LVN's literally were next up in chain of command from the CNA's. That's because the LVN was responsible for anything the CNA did, including tasks that they delegated.

As a CNA in LTC, our facility would not allow us to take vital signs, check blood glucose, do catheters, or pass medications. Other facilities may train CNA's to do that though. In all honesty the CNA's would have never had time to do any of those tasks anyway because they had 2 CNA's to 30 residents. LVN's spent the entire shift passing meds to 45 residents and staying late 1-3 hours charting.

I was proud to be a CNA, I liked that title. I think PCT would be confusing in LTC. You have residents, not patients. So RCT? I don't know. I wonder how other CNA's feel about that title? I liked that I was "certified" because it's self explanatory that since I was certified, I had training and passed a certification to be qualified. Anyone can be a PCT in the hospital (don't need CNA cert) and I really think CNA's should be proud that they are certified.

On a side note, ED is fantastic and their PCT's receive a lot of extra training to be able to do more tasks. I work on a med surg floor and they don't even allow PCT's to insert catheters or do IV's/phlebotomy.

Edited to add that everywhere I have worked CNA's/PCT's and nurses can all write each other up. Although it's not exactly a write up, it's an incident report type of thing. Anyone can e-mail our manager with a complaint either.

Your are right about the PCT title. Which is why I threw out the example of "nurse technician". My 17 year old daughter is a CNA, some of her stories brought back, less than fond memories. What state do you live in? In the states I have practiced, you have to have a CNA to become a PCT; I have worked in, IA, IL and.FL.

I would prefer to.leave the medication aspect to nurses only. In my mind it wouls work best to have a "Nurse Tech"/LN team. 10 patients max per team as well as a secretary. The Nurse and the Nurse Tech go into each room together, that way all tasks can be completed at once and on to the next room. The secretary would then answer lights. I would like to train our support staff to: change minor dressings, cath patients Sat Gs and anything else that is not PO/IVmed related. Please let them do digi-stems, lol. I also do not like that they cannot read patient charts. They need.to know what is going on as well.

The chain of command is what bothers me. It causes "power trips". I do not consider myself the boss of RNs and LPNs. IMHO, chain of command = bedside staff, shift supervisor, ADON, DON, ADMINISTRATOR.

In hospitals the support staff works under their.own credentials. If they screw up it is their butt on the line, not the Nurse.

I do not believe ALL CNAs are abused, however, a large percent are. Which in turn causes the CNAs to lash.back and abuse the Nurse.

I worked in 2 LTC as an aide and just this current one as a nurse.

Being told to do something is horrible. IMO, no.one should ever be "told" and if they have to be someone needs to be evaluated. Either the party doing the.telling or the person being told. If someone is being "told" to do something, maybe they need more training. If the person doing the telling prefers not to ask than they need more training. Would you feel okay with an LPN or CNA "telling" you to do something? Ex: Johns dressing was contaminated with stool as I cleaned him, go change that, before he gets an infection.

Edited by CrzyNrsBSN
Typos and adding

Adele_Michal7, ASN, RN

Specializes in Pediatric. Has 5 years experience.

Full disclosure. I didn't read every word of your post.

The part that caught my eye was "CNA's are told not asked... To complete tasks"

I don't know the spirit in which these nurses told their aides to complete a task, but...

From time to time, when I "tell" a CNA to do something, my reasoning behind not asking is this:

1. If I ask, I give them an option to say no

2. I'm asking in relation to a patient who's assigned to them, so most likely, "no" is not an option

3. When MY superiors (DNS, UM) tell me to do something, and I can't complete it... I let them know why and we switch gears/re-delegate accordingly

4. So if a CNA is unable to perform something, I'm trusting they will do the same with me.

I treat all my coworkers with respect, no matter what title or education level they hold

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

Your are right about the PCT title. Which is why I threw out the example of "nurse technician". My 17 year old daughter is a CNA, some of her stories brought back, less than fond memories. What state do you live in? In the states I have practiced, you have to have a CNA to become a PCT; I have worked in, IA, IL and.FL.

I would prefer to.leave the medication aspect to nurses only. In my mind it wouls work best to have a "Nurse Tech"/LN team. 10 patients max per team as well as a secretary. The Nurse and the Nurse Tech go into each room together, that way all tasks can be completed at once and on to the next room. The secretary would then answer lights. I would like to train our support staff to: change minor dressings, cath patients Sat Gs and anything else that is not PO/IVmed related. Please let them do digi-stems, lol. I also do not like that they cannot read patient charts. They need.to know what is going on as well.

The chain of command is what bothers me. It causes "power trips". I do not consider myself the boss of RNs and LPNs. IMHO, chain of command = bedside staff, shift supervisor, ADON, DON, ADMINISTRATOR.

In hospitals the support staff works under their.own credentials. If they screw up it is their butt on the line, not the Nurse.

I do not believe ALL CNAs are abused, however, a large percent are. Which in turn causes the CNAs to lash.back and abuse the Nurse.

I worked in 2 LTC as an aide and just this current one as a nurse.

Being told to do something is horrible. IMO, no.one should ever be "told" and if they have to be someone needs to be evaluated. Either the party doing the.telling or the person being told. If someone is being "told" to do something, maybe they need more training. If the person doing the telling prefers not to ask than they need more training. Would you feel okay with an LPN or CNA "telling" you to do something? Ex: Johns dressing was contaminated with stool as I cleaned him, go change that, before he gets an infection.

Just a note to say that CNAs in MY hospital work under their CNA certification, but I as the RN am ultimately held responsible for what is delegated to them and whether it is completed correctly. Also I have no authority to 'write them up.'

But there is ALWAYS an option. They are able to say no

What if they are in the middle of ambulating an unsteady patient, and you say Ms. Jones needs, such and such now. The aide cannot say no? Also,if they aren't doing anything, they have the option, still, to say no. It might cost their job,but it is an option.

In my mind, and please do not get defensive, you aren't anyone's superior unless you are in a managerial position.

This is exactly what I am saying. If we have competent employees, delegation is not needed. I do not check to make sure the techs do their job correctly. I am not required. I also do not feel the need to. They are competent and if I felt they weren't, I would take my concern up the chain of command because they would need to seek employment elsewhere. I need all staff to save lives! Not **** up!

Edited by dianah
Terms of Service

I feel the pride in this thread. Honestly I've worked with some amazing CNA's and also worked with some that I found not suitable to give care. I feel my generation( 20 something yr olds) feel like they're owed something and could care less about giving care. Disclaimer this is my view of the situation and the CNA staff I have worked with prior. I love teamwork..... But everybody has to buy in to helping each other that(team).

Thank you for understanding what I am saying without.trying to throw around power. No one is entitled to respect they did not earn. I did not want this to turn into any type of argument (not that it really has) I just wanted nurses and CNAs to come together and possibly raise some of these points to their current employer

OP, it took a long time before management caved in and allowed charge nurses to write up CNA's. Ever since they gave that to us, I have seen a lot less "sitting around" and the floor nurses are a lot happier. I can even tell that the floor nurses are less stressed out because CNA's are being held to some degree of accountability.

I am in a different position, but as I've said numerous times before, education equals entitlement. I don't see why floor nurses shouldn't be entitled to more down time than CNA's. There is a tradeoff between bein a licensed professional (for the sake of this post, I am including LPN's) and a CNA. CNA's DO NOT miss their breaks. They have their entitlement and if a patient or resident is soiled, another CNA has to assume responsibility. On the flip side of things, I, or even floor nurses have to attend to certain situations regardless of whether or not we are on break.

CNA's are also not responsible for the level of documentation nurses are. I NEVER see CNA's staying late; however, I sometimes see the previous shift's nurse staying late to finish. I've even had to stay late a few times (and not just to finish a level of candycrush).

I know where you are coming from and I hear it from several CNA's I work with. When they approach me with a sob story about how the floor nurse delegated them a patient or resident that wasn't assigned to them, I tell them to step into my office, shut the door and tell the CNA to take a seat. I then pick up the "Injured At Work" form and put it in front of them while picking up the phone and telling them "let me call the whaaaaaambulance."

Karou

Specializes in Med-Surg. Has 1 years experience.

Your are right about the PCT title. Which is why I threw out the example of "nurse technician". My 17 year old daughter is a CNA, some of her stories brought back, less than fond memories. What state do you live in? In the states I have practiced, you have to have a CNA to become a PCT; I have worked in, IA, IL and.FL.

I would prefer to.leave the medication aspect to nurses only. In my mind it wouls work best to have a "Nurse Tech"/LN team. 10 patients max per team as well as a secretary. The Nurse and the Nurse Tech go into each room together, that way all tasks can be completed at once and on to the next room. The secretary would then answer lights. I would like to train our support staff to: change minor dressings, cath patients Sat Gs and anything else that is not PO/IVmed related. Please let them do digi-stems, lol. I also do not like that they cannot read patient charts. They need.to know what is going on as well.

The chain of command is what bothers me. It causes "power trips". I do not consider myself the boss of RNs and LPNs. IMHO, chain of command = bedside staff, shift supervisor, ADON, DON, ADMINISTRATOR.

In hospitals the support staff works under their.own credentials. If they screw up it is their butt on the line, not the Nurse.

I do not believe ALL CNAs are abused, however, a large percent are. Which in turn causes the CNAs to lash.back and abuse the Nurse.

I worked in 2 LTC as an aide and just this current one as a nurse.

Being told to do something is horrible. IMO, no.one should ever be "told" and if they have to be someone needs to be evaluated. Either the party doing the.telling or the person being told. If someone is being "told" to do something, maybe they need more training. If the person doing the telling prefers not to ask than they need more training. Would you feel okay with an LPN or CNA "telling" you to do something? Ex: Johns dressing was contaminated with stool as I cleaned him, go change that, before he gets an infection.

I have only worked in Texas. Here hospitals can hire people with no healthcare experience or certifications and they are trained to be PCT's. Many are CNA's though, and we also have several PCT's who are in nursing school.

I love your idea of teams and 10 patients, I wish that would happen! It's really unfortunate how LTC's are ran with as minimal staff as possible. I don't see ratios improving in Texas anytime soon :(

Even in the hospital if the PCT causes an error (example: did not apply bed alarm and patient fell) both the nurse and PCT are in trouble and written up. That's because ultimately everything falls under the responsibility of the RN. We are held responsible for the mistakes of a PCT.

I suppose in the hospital, when things can get critical very quickly, it just doesn't bother me if I need to be told to do something or if I need to tell someone to do something. I would love not to have to tell or ask someone else to do their job, but since I am responsible for ensuring that things get done, I do. Example: PCT did not chart daily weight or intake/output, which is their responsibility to chart but mine to make sure that they do. I might remind this PCT to chart that information or tell them they need to do it. I usually ask instead of tell, but sometimes if I have repeat myself and ask over and over again then I have to tell.

I have never taken offense when someone tells me to do something, as long as it's legitimate and not done in a rude manner. I have been told by the PCT "hey you need to help me turn this patient", or "go to room 35, Mr. Smith is complaining of chest pain". My charge nurse may tell me, "tele monitor called about 39, their heart rate is 130, you need to check on them". I don't have a problem with any of these. I know my coworkers, and I know if they tell me to do something then it's important. If there is any rudeness or attitude, that's a whole other situation.

Karou

Specializes in Med-Surg. Has 1 years experience.

But there is ALWAYS an option. They are able to say no

What if they are in the middle of ambulating an unsteady patient, and you say Ms. Jones needs, such and such now. The aide cannot say no? Also,if they aren't doing anything, they have the option, still, to say no. It might cost their job,but it is an option.

In my mind, and please do not get defensive, you aren't anyone's superior unless you are in a managerial position.

Always say no? I can't always say no, how can they? Sometimes we can say no. Sometimes we should (like in your example). But if you are ever asked or told to do something within your job description, and it's safe, there is no reason to refuse it and say no. That's nurses, PCTs, pizza delivery drivers, anyone. In healthcare we are a team and if you refuse to do something without good reason then you are a poor employee and need a serious discussion with your manager.

I mean... I can say no to paying my bills, going to work, or filing taxes but that has major consequences.

Karou

Specializes in Med-Surg. Has 1 years experience.

This is exactly what I am saying. If we have competent employees, delegation is not needed. I do not check to make sure the techs do their job correctly. I am not required. I also do not feel the need to. They are competent and if I felt they weren't, I would take my concern up the chain of command because they would need to seek employment elsewhere. I need all staff to save lives! Not f**k up!

Most nurse practice acts say you are required to follow up and check tasks that you have delegated to a CNA. Is there anywhere that this isn't a standard and requirement? I mean, the responsibilities of delegating are literally taught in nursing school...

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

Big yawn. There seems to be one post every day or two by someone with an overwhelming sense of entitlement and inflated ego who can not accept that CNAs and PCTs work under the delegation and supervision of the Registered Nurse. Most of these people can not spell "delegate" and come here to trash Registered Nurses who are simply asking them to do the job they were hired to do. It is too bad that we can't report posts that are rude mean and dumb.

This is regulated by your State's Nurse Practice Act. It is the law. It spells out the scope of an RN license to practice and the scope of an unlicensed certified nursing assistant and they are definitely not equal. Techs in hospitals do not work under their own credentials in nursing care areas; that is absurd.

These are not difficult concepts. Please refer to Boards of Nursing Forum if you need clarification.

An ER team of physicians, PAs, NPs, RNs and techs, who are usually ex military medics and corpsman who understand chain of command, is not remotely similar to a LTC facility and a lone LPN or RN responsible for 20 to 40 residents, the CNA staff and the staff's behavior as well.

Straight No Chaser, ASN, LPN

Specializes in Sub-Acute. Has 5 years experience.

I had the same experience in LTC. My only answer is that those nurses who delegate out of convenience truly ARE on a power trip. I think sometimes they feel "less than" for whatever reason and sometimes they're just jerks who truly don't think they should have to do "CNA work". Many absolutely DO feel that CNAs aren't smart or worth much, probably because they never did the job themselves. ALL nurses should have to work at least a few weeks as a CNA just to get an idea of how incredibly exhausting and demanding it is. (Yes, I KNOW nursing is also exhausting and demanding, but the pay is higher and it's not as hard on the body).

Now, it obviously also happens that CNAs can be lazy and disrespectful and certainly lots of nurses do their best, but the ones who don't surely make it unforgettable.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

I can tell you are really passionate about this topic. I started out as a CNA in LTC, worked at the same facility later as an LVN, and now work in a hospital as an RN.

How many LTC/NH facilities have you worked in? I ask because I have only worked at one (for four years) and I never saw that kind of attitude towards CNA's. When I was a CNA, I was always treated with respect by the nurses (LVN's, our only RN's were the DON and ADON). We worked together as a team because we had to in order to survive in that environment. LVN's did delete to me, which was always appropriate. I wasn't always asked to do things, sometimes I was told, and that was okay with me because it was always fair and something important that I was being told to do. In LTC, the LVN's literally were next up in chain of command from the CNA's. That's because the LVN was responsible for anything the CNA did, including tasks that they delegated.

As a CNA in LTC, our facility would not allow us to take vital signs, check blood glucose, do catheters, or pass medications. Other facilities may train CNA's to do that though. In all honesty the CNA's would have never had time to do any of those tasks anyway because they had 2 CNA's to 30 residents. LVN's spent the entire shift passing meds to 45 residents and staying late 1-3 hours charting.

I was proud to be a CNA, I liked that title. I think PCT would be confusing in LTC. You have residents, not patients. So RCT? I don't know. I wonder how other CNA's feel about that title? I liked that I was "certified" because it's self explanatory that since I was certified, I had training and passed a certification to be qualified. Anyone can be a PCT in the hospital (don't need CNA cert) and I really think CNA's should be proud that they are certified.

On a side note, ED is fantastic and their PCT's receive a lot of extra training to be able to do more tasks. I work on a med surg floor and they don't even allow PCT's to insert catheters or do IV's/phlebotomy.

Edited to add that everywhere I have worked CNA's/PCT's and nurses can all write each other up. Although it's not exactly a write up, it's an incident report type of thing. Anyone can e-mail our manager with a complaint either.

In my state, "Patient Care Tech" or "Clinical Technician" is a protected title and requires a year of classes AND a CNA license. I'm not sure what type of education CNAs get -- we don't have any in our ICU. I'm responsible for their evaluations, so I see the feedback that our nurses provide on each tech. I have to say that some techs are awesome: work hard, know their stuff and have a good attitude. Others are lazy, hide from the nursing staff, profess not to know anything about anything so they don't have to DO anything and have a lousy attitude. Their evaluations reflect their feedback.

As far as delegation -- some nurses do it well and others not so much. The clin techs have the right and means to give feedback on THAT, and that is reflected in the evaluations the nurses are given from their evaluator. Unfortunately, the peer review process is anonymous, and I don't think that gives us the best outcomes. It is my belief that if you're going to give feedback on someone which affects their evaluation and thus their raises, you ought to be held accountable for it. I cannot call the process unfair, however. The peer review on both clin techs and RNs is anonymous, the peer reviews provided by both clin techs and RNs is anonymous and everyone is given information on the process when they go through orientation. So it's applied equally to everyone and you know about it in advance.

Full disclosure. I didn't read every word of your post.

The part that caught my eye was "CNA's are told not asked... To complete tasks"

I don't know the spirit in which these nurses told their aides to complete a task, but...

From time to time, when I "tell" a CNA to do something, my reasoning behind not asking is this:

1. If I ask, I give them an option to say no

2. I'm asking in relation to a patient who's assigned to them, so most likely, "no" is not an option

3. When MY superiors (DNS, UM) tell me to do something, and I can't complete it... I let them know why and we switch gears/re-delegate accordingly

4. So if a CNA is unable to perform something, I'm trusting they will do the same with me.

I treat all my coworkers with respect, no matter what title or education level they hold

Very well put. I love this response.

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