MSN, RN, NPD-BC
Congratulations! If you’re reading this, you have overcome probably one of the most challenging phases of your life — nursing school. You are now a registered nurse (RN)! Whether you are preparing to start your first nursing job, or you’ve already started, there may be hurdles you come across during this transition.
Before I begin, I want to clarify that different institutions use different titles for unlicensed assistive personnel (UAP), such as certified nursing assistant (CNA), patient care assistant (PCA), or patient care technician/tech (PCT). As a student nurse extern, you might have functioned in these roles. For this article, I will use the general term UAP.
Transitioning from the role of UAP to RN can be challenging, especially if your first nursing job is on the same unit where you were a UAP.
One challenge some new RNs may face is familiarity — that the UAPs they worked alongside will still view them as a UAP.
Sometimes, RNs report feeling uncomfortable with even delegating certain tasks. The thought process may be: “What if I mess up? I am now the delegator instead of the delegatee. Everything I do is now under MY license,” or, “What if the UAPs don’t respect me as a nurse?” or “How do I delegate to the people who I used to work side by side with?”
Here are some practical tips to make the transition to being a nurse who delegates well a little more seamless.
In the paragraphs to follow, I’ll encourage you to team up to get the job done or just do certain tasks yourself. This is by no means a message to not ask for help. On the flipside, just because you know how to do it all, doesn’t mean you should.
Asking for help in a respectful manner and incorporating other strategies into your delegating will make your shift easier and slow down the road to burnout.
RELATED COURSE: Nurse Burnout
Delegation is much more than giving someone a task to do. It involves clear communication and partnership.
Merriam-Webster defines “delegate” as “to assign responsibility or authority” or “to entrust to another.” And one of its definitions for “delegation” is “the act of empowering to act for another.”
So by definition, “delegation” indicates that you trust the individual to whom you are delegating. This means a UAP should be viewed and treated as a trusted team member. The definitions also indicate that RNs should empower UAPs to complete the requested task.
As a trusted team member, a UAP should be made aware of the shift plan. Shift report is a great time to communicate the plan and discuss priorities. This also provides an opportunity for the UAP to share what can be completed during the shift.
Just as much as we should view UAPs as trusted team members, RNs also should model what a trusted team member looks like. Trust and respect grow from building rapport. This goes hand in hand with communication.
For instance, shift report is a good time to get a sense of the strengths and weaknesses of the UAP you’re working with. This could look like asking what they’re comfortable with, or if they need assistance. Modify your communication depending on the UAP’s experience. Sometimes teaching may be needed.
Becoming an RN is an extension of the skills you obtained as a UAP, not a replacement for those skills. This is the time to build on that foundation.
Being a former UAP prepared you for this moment. Never discount the importance of that foundation. Remember that being an RN does not exempt you from performing certain tasks. If you see that your UAP is busy, find ways to meet them halfway.
For example, if your patient needs a bath during a busy shift, there’s nothing wrong with offering to bring the supplies to the room, washing the front of the patient, then calling the UAP to help with turning to complete the bath. Or vice versa, asking the UAP to start the bath and then you come in for turning. When UAPs feel supported, they will have no problem supporting you.
Nursing also requires you to cluster care. Say your patient needs their blood glucose checked before you can give medications. Communicate with the UAP to prioritize obtaining that fingerstick first. If you don’t get a chance to communicate that to the UAP and they are already in another patient’s room, you can bring the glucometer into the room with your prepared medication. At that point, you can obtain the glucose level and administer medications in one visit.
Consider this:
When I worked in a medical intensive care unit, short staffing led to one UAP being scheduled for a 20-bed unit. One patient was on a continuous insulin drip and needed a blood glucose check every hour. The patient’s nurse circled the unit multiple times and could not find the UAP. Eventually, the nurse told charge nurse, “I want to inform you that ‘Melissa’ is missing, and I need a fingerstick. I have been looking for her for at least 15 minutes.”
The charge nurse calmly said, “She is off the unit at the moment to assist another nurse with transporting his patient to MRI. This is something that probably should have been communicated to you. My apologies. Are you busy with your other patient?”
The nurse replied, “No,” prompting the charge nurse to respond, “In all the time it took to look for her and then find me to report what she did not do, you could have obtained the blood glucose.”
The nurse silently nodded and entered the patient’s room.
The moral of the story is just because tasks can be delegated doesn’t mean you cannot complete them as a nurse. Remember, this is about teamwork and providing the best possible patient care, especially if there’s an urgent need. In this instance, time was of the essence. The blood glucose needed to be checked in order to titrate the insulin drip.
Being a UAP can feel like a thankless job. It’s common for UAPs to feel like they’re being pulled in a million directions. Expressing gratitude is a powerful way to encourage a UAP, especially when feeling burned out.
This goes back to the definition “empowering to act for another.” Saying, “thank you,” seems obvious. However, transparently, sometimes we as nurses can become so consumed with our workload that we do not take time to give an intentional expression of gratitude. Even if it means a shoutout in a staff meeting or huddle, any small gesture counts.
It might be intimidating to transition from an unlicensed assistive personnel role into a new role, and delegation can be uncomfortable. But you are not alone. A delegator is not synonymous with a taskmaster. Keep that in mind, and you’ll be delegating effectively in no time. Remember that teamwork makes the dream work. You are well on your way to being a master delegator and awesome nurse. I wish you all the best!
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