Prioritization and delegation in nursing: who first, and who does it?
Six decisions a practical nurse makes with several clients: who to see first, what to do first, and which tasks to assign to whom.
- A threat to life comes first, then a new change.
- Assign a routine task for a stable client.
- The client is still yours after you assign a task.
Prioritization decides which client and which action come first. Assigning decides which tasks another person can do, and who that person is. This guide gives the rule for each of the six decisions, and links to a lesson on each one.
Two questions run through every shift
A practical nurse with several clients answers two questions all day: who needs me first, and who can do this task? Each question breaks into three smaller decisions. Many textbooks and exam guides call the second question delegation. These lessons say “assign”.
Who do you see first?
Look for a threat to airway, breathing or circulation. If no client has one, assess the client who has changed from their own baseline. An expected finding still needs care, and it does not need you first.
Read the full lesson: which client do you assess first?
What do you do first?
Do first the intervention for the problem that can get worse fastest. Then look around the client: a hazard, the people on the unit, and how far away help is. Using the team is part of setting priorities.
Read the full lesson: which intervention comes first?
Is the plan still right?
A plan made at 07:30 can be wrong by 10:30. Check each plan against what is happening now, and decide to continue, change or escalate.
Read the full lesson: is the plan of care still right?
Which tasks can you assign?
Assign a routine task for a stable client when your employer's policy allows it and help is close by. You keep the assessing, the planning and the evaluating. A change in the client needs your assessment first.
Read the full lesson: which tasks can a nurse assign?
Who takes the task?
Choose a person who is allowed to do the task, who has been taught and checked on it, and who knows when to stop and call you. Do not assume that anyone is competent.
Read the full lesson: who do you assign the task to?
What do you say, and what do you check?
Say what, by when, what to tell you at once, and when to report back. Then follow up, because the client is still yours. A finding that someone reports to you needs your own assessment.
Read the full lesson: how to give a clear instruction and follow up.