A friend of mine, an experienced RN on a medical unit, expressed increasing frustration over her co-workers' inaction when nursing assistants push back on delegated assignments and dictate to nurses what they will and will not do despite their job descriptions. In the hour before shift change when teamwork is essential, nursing assistants have been found to be on their personal cell phones or cannot be easily located, leaving nurses hustling to answer call lights and assist patients, as well as do work only RNs can perform.
The nurses complain about the assistants' attitudes and work ethic among themselves, but do nothing further to resolve the issues. My friend role-models making clear assignments and setting expectations; the assistants know she means business and follow through. However, many of the nurses prefer avoidance, finding a new job, or trying to get someone else to talk to management to sidestep being the "snitch." None of these actions display nurse empowerment or solve the problem.
Regrettably, this situation is not an isolated one. A workplace culture that permits such lack of accountability arises when nurses are resistant to addressing issues by having direct and professional conversations with other employees. But conflict management comes with challenges-nurses fear being on the receiving end of subtle to overt incivility or bullying for confronting issues. Then, unless the problem is escalated up the chain of command, leaders cannot address what they do not know about. Clear expectations for job performance are essential, along with a zero tolerance for incivility and bullying at all levels. As with all employees, failure to meet role requirements or behavioral standards can lead to serious consequences, including termination.
The focus of delegation education is the professional decision-making required before delegating tasks to unlicensed assistive personnel to comply with State Board of Nursing regulations. But are nurses also educated to handle the workplace challenges that can arise? Especially daunting for newer nurses is delegating to assistive personnel who are older or have more years of employment. The newer nurse feels like the underling in directing the actions of an older person. However, nurses must learn to exercise their professional right to safely delegate as frontline leaders in patient care. Otherwise, culture can break down and an already heavy nursing workload will become overwhelming and unsustainable. Just bear in mind, "What you permit, you promote."1
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2022
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