Delegation is a tough thing to master as a new nurse. While the NCLEXNCLEX tells you which tasks are appropriate to delegate, it doesn’t exactly outline how to go about doing it.
I realize that not all units have certified nursing assistants (CNAs) or patient care technicians (techs), but many do. This post is for those of you that are faced with this particular challenge.
While you may have mastered it on the unit that you work on, if you transfer to another hospital or even a different unit within your same facility, it’s like you’re starting all over again.
I think delegation is tough because you’re a new person walking onto a unit, becoming part of a team, but you have to delegate various tasks to people that have been on the unit for years. Some have been informal leaders on the unit for decades. And let’s be honest, it can be tough to be told what to do by people you just met. You don’t trust them yet, you don’t know them, you don’t know if they’re good at their job. While that doesn’t excuse not doing what you should, I get it.
Here are some tips for molding yourself into the team quicker, which will, therefore, make delegation easier.
During orientation, observe how your preceptor interacts with your CNAs
How do they respond when they’re delegated to? Do they function well as a team, or do people work independently of one another in their silos of patients and let each other drown?
Observe from afar how things function.
If they respond well to them but later are not so great to you, you know you need to work at your relationship with them, and they may feel you need to prove yourself. Also, see how your preceptor goes about delegating. Are they good at it? Are they respectful and nice or do they act like the CNAs are their minions? Typically, preceptors are informal leaders within the unit and if the leader of the unit is mean to the CNAs, that behavior may continue to the rest of the nursing staff, which fosters a pretty tough work environment for everyone. You want to build a good relationship with your CNAs!
If you have a good and trusting relationship with your CNA’s, you will motivate them to give your patients phenomenal care. People want to do a good job for leaders they respect. If you’re a nurse – you’re a leader, whether you like it or not. You are the leader of your patient’s care team, and that includes your CNAs.
During orientation, work on building your relationship with them before you’re responsible for delegating
Get to know them (ask them where they’re from, how long they’ve worked there, if they’re in school, etc.). I don’t know about you, but when I’m at work and someone that is responsible for telling me what to do (like physicians, PA’s, NP’s, managers, assistant managers, etc.) takes the time to get to know me, I feel valued. I also like to try to get some inside joke going. Example: when I started at my current unit I figured out that one of the CNAs liked Kevin Hart stand-up. So I randomly quoted that, or when I asked her a question and she answered, I’d say “alright alright alriiiiggghhht!” in true Kevin Hart fashion. I may have yelled it a little loud it the unit, but whatevs. It got her laughing and facilitated the development of a relationship.
When you’re starting to be on your own, even during orientation, touch base with them first thing in the morning (or night!)
After you get the report and learn about your patients, touch base with them. Let them know your game plan for the day (who needs baths, who is traveling off the unit, who may discharge/transfer, who is a high fall risk). Even if they’re not responsive to this – do it. It establishes a routine and facilities communication and teamwork. And if they complain about it, make a joke out of it. “Humor me and let’s huddle for a sec! You know you love me!”
It’ll lighten the mood and make them more likely to jump on board. Then they know that whenever you’re working, you’ll track them down to touch base with them. They’ll expect it from you and it will become routine. While people may fight it at first, it’s better for patient care and teamwork in the long run. When the nursing unit functions as a team, the patients get better care, the staff is more satisfied, and everyone wins.
Understand where they’re coming from and their priorities
Remember when you were first becoming a nurse? Remember when things started to get hectic and you had trouble learning how to prioritize? Remember when all you wanted to do was the easiest things first, even if they weren’t actually the priority?
The natural human response when it gets really chaotic and you have many tasks that you need to complete is to do the things that you’re most familiar and comfortable with first. When you’re growing as a nurse, you’re learning how to see past that natural urge and do what the patient needs first. CNA orientation isn’t long or detailed enough to touch on that, so when you see that happening and you need to redirect them, be sure to explain the reasoning. “Hey, Mr. Smith in room 6 isn’t doing so hot right now. I know you have your rounds to do, but I need a full set of vitals on him STAT so that I can let the doc know about everything that’s going on. I’ll look up labs/meds.” (Also, that kind of phrasing is a subtle way of addressing the problem as a team.)
When they’re doing something incorrectly, nicely explain the correct way
For example, if they’re measuring urine output incorrectly from the foley catheter – take 5 minutes to nicely educate them. Foster an environment and relationship where they feel comfortable being honest with you when they don’t understand something or need further clarification. What does that look like? Don’t react like they’re stupid if they don’t understand something obvious to you, don’t go talk to other nurses and CNAs about how you can’t believe they didn’t know something, and don’t just take care of it yourself without talking to them and then get upset that you have extra work. Educate them, be honest with them, be nice to and understanding with them. I know when I was learning things in the hospital, sometimes it took a few times of someone explaining something for it to click. Be patient and kind.
Most people just want to do the right thing and make errors because they honestly don’t know. I’ve heard so many CNA’s say, “I didn’t know I was doing something incorrectly and then I overheard them talking about how I’m doing something wrong. I wish they would have just told me or taken the 3 minutes to show me the right way to do it. And now they’re complaining that they have all this stuff to do that’s my responsibility but I’m scared to ask them how to do it right because they’re just going to be a jerk to me.” Seriously, I’ve heard that so many times.
How it can feel when the nurses all talk about you when you didn’t know you were doing something wrong..
Say thank you
I sincerely appreciate a good CNA. My day is 900x better when I’m working with a CNA who is a team player, understands prioritization, and is making an effort to be efficient. Therefore, whenever I see people doing a good job, I say thanks and show some appreciation. I think about how I feel when a manager, assistant manager, physician, or NP/PA tells me I did a good job, and I want to extend that same courtesy to them.
Be considerate and work together
We all know call bells come in waves. So when 4 call lights go off and 4 of your CNA’s 8 patients need to go the bathroom simultaneously, help them out. Talk to each other and attack things as a team. I know we have a ton of things to chart and take care of, but leaving them hanging like that just isn’t cool. I know we need to chart (and have a lot to chart!), but expecting one person to take 4 people to the bathroom simultaneously just is not realistic. The name of the game is working with the least amount of staff on nursing units as possible, and if we don’t work together as a team to tackle call lights and patient needs, we’re all going to drown.
It’s also important not to think there is a task that only CNAs can do. Under your nursing license, you can do whatever they can do. However, it’s not always the most efficient for you to do those things. But, if you spend 15 minutes finding a CNA to do something you could have just quickly done yourself, that’s just as inefficient, if not more. It’s also pretty inconsiderate.
Here is the common CNA / nurse unwritten rule: if you, as a nurse or CNA, are charting or at the desk not doing anything in particular, and one of your patients needs something – you are expected to address it. If you are at the desk, catching up on charting and a coworker’s patient needs something and they are busy with another patient – you need to address it. The expectation is that they will do the same for you. That’s how well-functioning teams work. Not everything will always be equal, but patients will be safe and their needs will be addressed.
Charting is always something that can wait if a patient or family needs something. When I was a CNA, I had no clue how much nurses had to chart until I actually did it. If someone needed something and I still hadn’t charted my rounds, too bad… they had to wait. Now I realize how wrong that was because the nurses were much farther behind than I was but they sucked it up and took the patient to the bathroom. And I got out on time, if not early, and they stayed late to chart. Sometimes they stayed hours late charting. Looking back, I see how inconsiderate that was and how that may have contributed to a rocky RN-CNA relationship.
If you are not a nurse, please read this post where I wrote out all of the things nurses are responsible for charting on each patient. It’s beyond excessive and millimeters away from unrealistic. And I even forgot some things and people added it in the comments!
So, that’s my delegation orientation in a few hundred words and 7 GIF’s. Does your unit work well as a team? How do you go about delegating? What did that process look like for you at the beginning, and how does it look when you get new CNAs? And if you’re a CNA, what do you wish the nurses delegating to you knew?
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