04.03 Prioritization

Overview

  1. Nursing Prioritization
    1. What does prioritization mean?
    2. Categories of prioritization
    3. Interdisciplinary Communication
    4. Prioritization Considerations

Nursing Points

General

  1. What does prioritization mean?
    1. Ranking a situation in urgency or whatever requires immediate action first
      1. Emergent
        1. Airway
        2. Breathing
        3. Circulation
        4. Safety
      2. Urgent
        1. Time sensitive tasks
        2. Risk for emergency
      3. Not-Urgent
  2. Interdisciplinary Communication
    1. Consider the priority
    2. Communicate cordially
    3. Follow HIPAA
      1. Disclose information only when necessary
    4. Delegation
  3. Considerations
    1. Maslow’s Hierarchy of Needs
      1. Consider individual patient’s needs vs other patients
      2. ABC-Safety
        1. Physiologic Needs first
    2. Efficiency
      1. Cluster care
    3. Stat Orders/Stat Labs
      1. Follow policy
      2. Recognize impact that the orders and labs have on the patient
    4. Prioritization is subject to frequent change
      1. Be adaptable to change

Nursing Concepts

  1. Prioritization
  2. Clinical Judgment

Patient Education

  1. Explain priorities to patients when addressing families
    1. Example: Explain that even though the sweet grandmother needs to go to the restroom, your patient in your other room needs your immediate attention (delegate to an UAP and follow HIPAA)

Reference Links

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Video Transcript

All right, we’re gonna talk about prioritization. Now, as a nurse, it’s all about priorities. Prioritization is one of the critical functions and critical things that we do as a nurse. When we’re taking care of multiple patients, and you have multiple tasks to do for each patient, it’s important that we know how to prioritize that care.
So, what is prioritization? It’s an action based on order of importance or urgency. And it can affect a patient, multiple patient, or even an organization as a whole, not just a single patient, but we may have to be prioritizing between many different groups of patients, and it’s part of the nursing process. It helps us to identify which situation should be addressed first.

So, prioritization in nursing addresses levels of urgency. We have emergent situations. We have urgent situations, and we have not emergent situations. So, what does that all mean? Emergent situations must be done and must be dealt with right now. Like, you better be doing something about it right now. These things are like ABCs. And example of this might be a patient’s who’s hypotensive. They have a weak thready pulse, and their consciousness is declining. We need to do something right now with that patient.

The urgent situations, these are things that must be dealt with soon. If we have an emergent situation, we deal with that first then we can deal with our urgent situation. These are time sensitive things. Things like, meds, labs, dressing changes. Now, if a patient’s in pain and they need pain medication, we need to deal with that. It’s not emergent, but it’s urgent. We need to deal with it soon.

Then we have not emergent situations. These can be done later, or they can be done last. After we dealt with our emergent situations, dealt with our urgent situations, then we can deal with our not emergent situations and things. Those would be things like daily bed sheet change. So, changing linens, baths, things like that. We don’t have to do them right now. We don’t need to do them soon, but they need to be done.

Now, if we plug this in with Maslow’s Hierarchy of Needs, we can really start caring for our patients in the appropriate level of priority.

While we’re talking about prioritization, it’s important we consider interdisciplinary communication, because this is where all the different functions in the hospital are gonna really have to start working together. So for example, if we have a hypotensive patient, that’s something that we must be in there dealing with right now. So, PTs gonna need to come and ambulate another patient we’re taking care of so that we can stay with our hypotensive patient during this hypotensive situation.

Now, it’s important when we’re dealing with the different disciplines that we be cordial. Critical situations can become very, very stressful, so we gotta be careful that we’re watching our tone, we’re watching our body language. We never know who’s listening. We don’t know if a patient’s listening. We don’t know who the other person is, so we gotta be very careful.

It’s also important to realize that we’re building report between different providers. Don’t be rude. There’s no need for that in the hospital. There’s no need for that, even in these stressful situations. Hospitals are very small places, and reputations spread. Just be cool, work with everybody else and be cordial in these situations. Even when it’s stressful, you can be respectful to other people.

Make sure that you’re following HIPAA. We gotta be sure that we’re only disclosing minimal information and necessary information. Critical situations can force you to disclose information at bedside, and sometimes that our patients would be succinct, be articulate and make sure that your answers don’t share any personal health information with other patients. So, be very careful of that in these situations.

Now, delegate when necessary. You can have other available nurses or techs perform tasks that allow you to address more important, or higher priority situations first and that’s the purpose of a healthcare team.

Now, some things to keep in mind. When considering nursing prioritization, consider Maslow’s Hierarchy of Needs. We talk about this a lot, but consider Maslow’s Hierarchy of Needs as you’re doing this. When you’re caring for multiple patients, consider what patient needs need to be dealt with first, and then, also, what patients need to be dealt with first. Do you need to take care a certain specific need of an individual patient or do you need to be taking care of a different patient before you address all your other patients? Really think about ABCs to help guide you here.

Now, consider your time. You gotta be very efficient as a nurse. One thing that we can do is something called cluster care. With cluster care, you plan to take care of more than one task at a time when you enter a patient’s room. Make sure that you’re not going in doing one thing, leaving, then having to come back to do another thing. If you can do the bath, the bed sheet change, the meds and different care all one time, make sure you’re doing that. That’s helping to keep your time free for if different emergent situations arise.

Take care of your stat orders and your stat labs. Follow institutional policies on stat orders and stat labs to make sure you’re doing them according to your healthcare facility. Recognize the impact that these orders and labs have on your patient, as well. For example, if you get a hemoglobin value come back from the lab, and one patient has a 6.8 and another patient has a 3.8, both of those are critical labs, but your patient who has the 3.8 is far more urgent and far more emergent than your patient that has a 6.8. So, make sure that you’re dealing with those values and those labs as you need to, in dealing with the more important ones, the more urgent ones first.

Now, prioritization is a fluid process. So keep this in mind, you must be adaptable. Your priorities for your patients, for yourself and for your shift are going to change at a moment’s notice. So, make sure that you’re always evaluating what your priority are at any given moment.

All right, what are some nursing concepts to think about with prioritization? First of all, the one to think about is prioritization, and the next one is clinical judgment. Make sure you’re using clinical judgment on the floor to care for your patients, to plan your shift and to prioritize care.
So, what are some key points with prioritization? Let’s just recap, real quick. You gotta evaluate the urgency of situations. Is it emergent, something that must be done right now? Is it urgent, something that must be done soon? Or is it not emergent, something that can be done later?

Consider Maslow’s Hierarchy of Needs with this. Think about a patient’s level of needs, and then compare those to other patients and other needs of that patient. What’s the most emergent thing that you need to deal with right now?

Then remember to cluster care. This helps in prioritizing care of multiple patients and it helps you keep your time in order, and help you get things done quickly so that you are free up if other emergent situations arise.

Be cordial. Realize that hospitals can be stressful places, but don’t let stressful situations detract from your professionalism. So just be cool, delegate when appropriate and realize that hospitals are small places. It’s important to remain professional.

Then, follow HIPAA. HIPAA is a law. Sometimes situations prevent us from leaving the bedside, so make sure you’re always following HIPAA. It is the law.

All right, guys. Make sure you check out all the other resources with this lesson, and make sure you review those and check those out. All right, make sure you review all the other resources attached to this lesson. Now, go out and be your best selves today. And as always, happy nursing.

Read more

  • Question 1 of 10

A nurse is working in the emergency department when a patient is brought in via ambulance for care. The nurse glances at the patient and realizes that there are many factors to consider regarding his care and she needs to focus on one area to begin. Which of the following questions should the nurse ask herself to determine the first priority intervention?

  • Question 2 of 10

A nurse is performing the initial assessment of a child with a history of acute leukemia who was brought into the emergency department. The nurse discovers the child has a temperature of 38.5C. Which action is the first priority in this situation?

  • Question 3 of 10

A nurse is trying to prioritize time according to the tasks that must be completed for the day. Which of the following elements must the nurse consider with prioritization? Select all that apply.

  • Question 4 of 10

You have a patient who needs to have a CT with IV contrast but is allergic to IV contrast. Which medication needs to be given first?

  • Question 5 of 10

During a busy shift at the hospital, a nurse continually gets bogged down with extra tasks and is unable to keep up with the workload. Which of the following is an example of a barrier to setting priorities? Select all that apply.

  • Question 6 of 10

A 36-year-old client with a history of epilepsy is in the hospital and experiences a seizure. For several minutes following the seizure, the client is calm but does not regain consciousness. The client then starts having another seizure. Which action is the first priority for the nurse?

  • Question 7 of 10

A nurse is working with a client brought to the emergency department in a comatose state after developing hyperosmolar hyperglycemic syndrome (HHS). The nurse ensures the client’s airway is patent and vital signs are stable. What is the nurse’s next priority in this situation?

  • Question 8 of 10

A 40-year-old female client with recent thyroid surgery has been admitted to the hospital with a fever, tremors, profuse sweating and anxiety. Based on this client’s symptoms, which drug class would be a priority to give to this client?

  • Question 9 of 10

Which of the following conditions is an example of a fourth-order priority for the nurse?

  • Question 10 of 10

Which is an example of a first-order priority need when providing patient care?

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