Many new nurses struggle to delegate patient care activities to nursing assistants. Sometimes it’s because they were working as a nursing assistant before they graduated and have trouble with role transition. Other times it’s because they may be working with older NAs who have been there for a long period of time. These more seasoned nursing assistants may be intimidating causing new nurses to avoid delegating anything to them.
However, independent of the reason, the only way you will succeed as a clinical nurse in today’s complex healthcare environment is to master the skill of delegation.
I work casual on a neuro-trauma step-down unit. We typically have two nursing assistants for approximately 20-25 patients. When I worked Saturday, my assignment wasn’t crazy (like it is sometimes) but I worked non-stop for my entire shift. When I left for the day, I felt good about the work I did. I spent time talking with a patient and his family about his post surgical constipation (a common conversation) and ways that he could “keep things moving” when he got home. I also taught a patient how to give herself Lovenox (she had a PE and was going home on Lovenox for a few weeks). And, I spent time trying to figure out why a patient with early stages of renal failure was coming in with metabolic acidosis (common for renal failure patients) yet she was taking her sodium bicarbonate. As it turned out, she didn’t think she needed the sodium bicarbonate and frequently missed doses. When I explained why she needed the bicarb (to counter the acidosis) she said, and I quote, “Oh my God! Why didn’t anyone tell me that? I just thought it was a vitamin or something.”
How was I able to spend the time teaching, investigating, and learning more about my patients (I now know all about my patient’s bowel habits AND the bowel habits of his entire family)? It’s because I delegated appropriately to my nursing assistant.
WHAT DID I DELEGATE?
· All AM care
· Removing a peripheral IV before my Lovenox lady went home
· Feeding my 89 year old patient her breakfast and lunch
· Blood sugars
· Getting my patients back to bed
IS IT DELEGATION OR DUMPING?
Now, there’s a difference between “dumping” on your nursing assistants and delegating. For example, if I asked my nursing assistant to feed my patient while I socialized at the nurses’ station or asked her to take out an IV while I’m in the room chatting – this could be perceived as dumping. Like the nurse who walks out of a patient’s room and searches down 3 hallways, 2 flights of stairs and 6 rooms (exaggerating a bit) to find the nursing assistant to put her patient on the bedpan – you’re going to lose the trust of your NA. That’s dumping – not delegating.
However, nurses HAVE TO DELEGATE appropriately so that we can do what we are good at – assessing, diagnosing, planning, implementing and evaluating care…oh…and teaching too!
Here's a tip: Avoid using the phrase, "Can you do me a favor". It implies that it really isn't their job and that they are just helping you out. Better to state requests in the form of "I need you to do x for our patient", "Our patient in room x needs to have his blood sugar checked at 11am. Can I count on you to do this?" etc. Always make the request focus on what the patient needs – not what you need.
Oh, and make sure you include them in the plan for the day. I always give report, discuss any concerns regarding patients and ask my nursing assistant if he/she anticipates any barriers to providing appropriate care (may have to relieve a sitter for lunch). They are a critical member of the health care team - treat them that way and you will gain their trust.
You are the licensed professional nurse. You do have authority and responsibility to delegate appropriate tasks to unlicensed personnel. Practice! The National Council of State Boards of Nursing offer a great tip sheet that explains the 5 rights of delegation. If you're struggling to delegate, click here to read.
I hope this tip helps you to succeed as a new nurse. I'm cheering for your success!
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