Care Training Online

Enabling Caregivers To Be The Best They Can Be

Management

The art of delegation and direction

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I’ve recently been contacted by a company who is reviewing their RN understanding of delegation and direction especially when working with unregulated staff. I thought I would discuss this topic today because it is something, Registered Nurses need to be mindful of and our responsibilities around this. I wonder how many of us have been on to the NZNC to review what our responsibilities are around delegation and direction?

The NZ Nursing Council describes delegation and direction as follows:

  • Delegation is the transfer of responsibility for the performance of an activity from one person to another with the former retaining accountability for the outcome.
  • Direction is the active process of guiding, monitoring and evaluating the nursing activities performed by another.

While it might be easy to delegate a responsibility, how do you really know the level of knowledge of the person you are delegating to? We are all good at assuming that a person knows, BUT how do we know? Have you monitored or evaluated the person to ensure they have the knowledge and skill to do the job because ultimately you are responsible for the care being delivered? This 3 min video explains it really well

The problem I see is with the amount of paperwork and the physical workload that is now the responsibility of the Registered Nurse. It can become very easy to delegate a job assuming the person knows what to do but lacking the time to monitor and evaluate the caregiver/support worker. 

I can see how easily this can happen as I constantly see on the ‘Facebook platform New Zealand Please Hear Our Voice’, the stress that nurses are under with their workload. Many people work long hours, do not take breaks and get burnt out, so how are you going to give direction to the person you are delegating the task too? It can be tricky.

Even if a person has a Level 2, 3 or 4 qualification, can you be assured they are competent at carrying out the delegated task? Unfortunately, you can’t. So how are you going to ensure the person has the specific training?

One way to get them to do targeted training for the task or tasks they are going to do, online. For instance, if you are dealing with someone in the community who has a tracheostomy, get them to show proof of understanding tracheostomies online. The same goes for any ostomy, including PEG feeding. I know for instance, that on Care Training Online, I have a training module that comprehensively covers these topics. It’s not an NZQA Unit Standard, it’s practical training and understanding of the topic.

So, targeted training is one thing but how are you going to monitor and evaluate their competence so that you are assured they know what they are doing. So here lies the problem. Unfortunately, there’s no other way but to actively assess them doing the job because ultimately, you, the Registered Nurse, is responsible for the care they are delivering.

It’s a very tricky situation but the one thing you must do at all costs, is protect not only your good name but your Practicing Certificate as well. You must not compromise yourself in any way. While I cannot tell you how to do this, as each organisation is different, I can tell you that you have to be proactive and find a suitable way for you to delegate and direct safely so you can be confident the person delegated is delivering safe care.

The Power of One Person

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If you ever thought that as one person you couldn’t make a difference then just look at what has happened in Auckland now. Because of one person, Auckland now faces another forced lockdown. How this could have gone so terribly wrong, beats me. While English as a Second Language may be a contributing factor, how does Get a test and self-isolate translate to get a test and go to the gym beats me. Let this be a lesson to us all.

Apathy is not unusual. I have heard many people say things like, “I cant do anything to change something” or “what is the point of voting, they don’t listen to me anyway”. Well take note, you can change something and your vote does count. One person has just locked down a whole city of 1.7 million people and restricted and disadvantaged yet another 3.5 million other people around the country. 

Let this be a lesson to us all. As a single person, we can make a difference.  While it may take a little longer to make that difference, and your motivation may be quite different (not that I am suggesting there was any motivation behind our latest community case not following the rules), and it might take a little longer to make a change, you as one person can and do make a difference. Still skeptical? Then check out this webpage.

So, what are some examples where one person has had a significant impact – and I’m not singling out good impact from bad. I’m just giving you some examples.

Maurice Hilleman has been claimed the greatest microbiologist of all times.  From humble beginnings, he went on to develop over 40 vaccines. Where would we today, without his ground breaking science. He used to say, every one should make a contribution in their lifetime, no matter how small.  Check out “The man behind the Science”.

Alexander Fleming who discovered the power of penicillin. He wasn’t able to bring it market on his own, because it was very unstable. But with two others, Howard Florey, an Australian Pharmacologist and Pathologist and Ernest Chain, a German- born biochemist. They managed to make this unstable product, stable. Just look at how many lives have been saved by them. Yes, we now are seeing the downside of over-use of antibiotics, we must not forget the good they do and the countless lives that have been saved. See more here.

And what abut Nils Bohlin, a Swedish mechanical engineer who invented the three-point seat belt. Look how many lives he has saved. Now all cars have to have seatbelts, which have been improved over time, and are now compulsory to be worn. View more.

While the above are a sample of the good people have done, let’s not forget that not everyone uses their power and influence for good. Just take Adolf Hitler. He was able to convince a whole country on his doctrine. He used his power and influence that caused the destruction of Jewish people and killing over 6 million people in World War 2. We all know how devastating that was. For more on Adolf Hitler. So, if you ever thought you couldn’t make a difference on your own, think again. The above are just a small sample of how people can change a world for good or bad. 

Managing stress in a stressful environment

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This month I want to discuss self-care. The reason here, is the few people I have spoken to over the last month, tell me how constantly busy they are.  I know I put a TED talk in last month about triaging your crazy busy life, but I thought I would address it again about how to keep yourself safe and as stress free as possible. You might like to take another look at the TED Talk.

Stress is something we can’t get away from, but it is how we manage the stress we are under that is important. Telling yourself how busy you are, is only going to make yourself more stressed and ultimately you get less done.  So, think about how important your self-talk is. I had an interesting talk with my grandson recently about fear.  He was to attend a new swimming class and he said to me “I am scared, and I have a headache and a funny tummy”. When I asked him why, he told me because it was new, and he didn’t know anyone in his class. So, what did we talk about?

Firstly, it is natural to be fearful when you are to attend something new, but once you get there and start the swimming, you will find the headache and the funny tummy, will go away. Of course, this is what happened. The fear went away, the tummy settled down and he got into the swimming.

What is interesting though, he is now using the skills we talked about to help coach his mates through fear. I witnessed him encouraging a mate, who could not swim, to use a surfboard in the pond on our property. He is turning out to be a wonderful, patient teacher. Very encouraging and instilling trust with his colleagues. What a wonderful skill for an 8 year old to have. His teachers tell us he is doing this to help others at school to. This of course will stand him in great stead throughout his life and what’s more, he is now seeing the positive results from his mates with their confidence soaring.

Now a big part of your job is to keep the staff together. Often you may feel there is no one there for you. It can be a very lonely place at the top because you cannot afford to fall apart. Boy do I know that. In 1989, I was the charge nurse of a long-term care ward in the public sector. This was when all long-term care was taken out of the public system. Our ward was the last to close and I chose redundancy as my option. Others on my ward were also being made redundant. Our ward was the holding pen so to speak for them. It was a hard time and I couldn’t afford to fall apart. I had to keep everyone together. I know how important and hard it is and how alone you sometimes feel. So how can you take care of yourself, while keeping the team together? 

I believe the first thing to do in selfcare is to not be hard on yourself if you don’t get everything done you wanted to do. Take a breath. Write a list.  Now ideally prioritise the list in order of importance if you can but that in itself can increase your stress.  It just takes more ‘brain time’ in an already overloaded brain and it may be just too much. So, just get them out of you head onto paper and tick them off when completed. What doesn’t get done today, can wait till tomorrow.

Don’t take your frustration out on your staff or loved ones. They are relying on you to keep everything functioning. Hard and all as it is, don’t let them fall apart because you are falling apart. Take a breath and tell yourself you can do this, and you will get through it. It’s amazing what happens when you say you can rather than you can’t.

Take care of yourself. Get a massage, go for a relaxing walk, meet up with friends in the best way you can (you can do this electronically just as well)  Put some oils in an infuser, listen to some music or learn meditation or mindfulness. These are amazing tools for quieting your very busy mind. If you do not know how to meditate, just find a guided meditation on you tube, sit or lie down and relax. Take a few deep breaths and just listen to the meditation, preferably via headphones and see how it subtly changes the way you feel. 

I guess finally you should always have hope. When you have hope, then life has some meaning, so don’t lose hope. This current state will pass, and you can then look back with pride, so take care of yourself now. If you are worried about how to manage your stress, there are some great tips here.