Nurses: How to Delegate Gracefully
Channel: EmpoweRN
Date: 2017-09-25

I love how when I was taking the NCLEX that delegation was the correct answer for many questions. However, when you get out into the real world you are working with different situations and personalities. It is not nearly as simple as the NCLEX made it out to be. It really does not matter how much you have going on, you may not be able to delegate things that seriously need to be delegated.  
I remember one time, I started my shift and I noticed a patient who was in the beginning stages of respiratory distress. She was rapidly declining and I needed time to focus on her. I had another patient who really needed to be changed, she already had a stage 2 pressure ulcer and it seemed like she was in danger of it worsening if she was not changed and turned soon. My other patient however needed my attention and I reviewed her labs and vital signs as I asked the nursing assistant to change the patient with the pressure sore.
I ended up calling a code sepsis at 0740 for the patient who was rapidly declining because I noticed that her WBC’s increased from 14-22k. Then I also noticed that her creatinine had increased more than 0.5. This made her qualify for a code sepsis. The code took a very long time, I was not finished until around 9am after I transferred her to the ICU. When I returned I was really behind, but was doing my best to catch up.
I started doing my best to catch up and eventually returned to my patient who I asked the nursing assistant to change. She had not touched the patient and it had been more then 2 hours now. Words cannot express how upset I was; I remember changing the patient myself with tears rolling down my face. It had been such a hard morning, and I clearly asked her to change this patient… why didn’t she do it?
This nursing assistant did not have a huge load, she was assigned to 10 patients. She also had time to complete the vital signs because she had started at 0700. The blood sugars were completed by the night shift NA’s at 0630. After I changed the patient, I went to speak with her. I told her that I changed the patient, however, if she needs help with anything else later to please let me know.
I know this response may surprise you. Why did I change the patient and why ask if she needs help. It is simple. In the future, I may have to work with this person again, hopefully she will remember this incident and realize that I’m not out there to get her. I’m just there to take care of my patients. I look at this as sort of, sewing seeds and honestly, usually it works! 
I wish it was as easy as delegate and move on, however, we are working with individuals who we have no idea what they might be going through. For us to simply judge someone off of one experience I think is just wrong. This was my first day ever working with her, and I want to keep an open, loving mind. 
Should this be a continual thing, I will of course report the behavior. However, since I did have the emergency, I did not see everything she was going though. Perhaps the other nurses were also demanding more than possible from her or perhaps the patients were… I just don’t know. However, I do know that if we judge and punish others quickly, we will also treat ourselves the same way. So in order to prevent this in the future, I try to be more loving and forgiving at all times. 
I hope this helps!
See you next week for some motivation!

~Caroline 
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