Prioritization

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Jon Haws
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Included In This Lesson

Study Tools For Prioritization

Trauma – Assessment (Emergency) (Mnemonic)
Nursing ABCs- Prioritization (Cheatsheet)
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Outline

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)

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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.

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Concepts Covered:

  • Test Taking Strategies
  • Respiratory Disorders
  • Prenatal Concepts
  • Prefixes
  • Suffixes
  • Legal and Ethical Issues
  • Preoperative Nursing
  • Bipolar Disorders
  • Community Health Overview
  • Immunological Disorders
  • Childhood Growth and Development
  • Medication Administration
  • Adulthood Growth and Development
  • Learning Pharmacology
  • Anxiety Disorders
  • Basic
  • Factors Influencing Community Health
  • Integumentary Disorders
  • Trauma-Stress Disorders
  • Somatoform Disorders
  • Fundamentals of Emergency Nursing
  • Dosage Calculations
  • Depressive Disorders
  • Personality Disorders
  • Cognitive Disorders
  • Eating Disorders
  • Substance Abuse Disorders
  • Psychological Emergencies
  • Hematologic Disorders
  • Pregnancy Risks
  • Concepts of Population Health
  • Emotions and Motivation
  • Delegation
  • Oncologic Disorders
  • Prioritization
  • Postpartum Complications
  • Endocrine and Metabolic Disorders
  • Basics of NCLEX
  • Fetal Development
  • Labor and Delivery
  • Gastrointestinal Disorders
  • Communication
  • Concepts of Mental Health
  • Health & Stress
  • Labor Complications
  • Musculoskeletal Trauma
  • EENT Disorders
  • Urinary Disorders
  • Urinary System
  • Digestive System
  • Central Nervous System Disorders – Brain
  • Integumentary Disorders
  • Tissues and Glands
  • Developmental Theories
  • Postpartum Care
  • Cardiovascular Disorders
  • Renal Disorders
  • Newborn Care
  • Disorders of Pancreas
  • Upper GI Disorders
  • Liver & Gallbladder Disorders
  • Renal and Urinary Disorders
  • Newborn Complications
  • Neurologic and Cognitive Disorders
  • Cardiac Disorders
  • Musculoskeletal Disorders
  • Female Reproductive Disorders
  • Shock
  • Infectious Disease Disorders
  • Nervous System
  • Hematologic Disorders
  • Disorders of the Posterior Pituitary Gland
  • Psychotic Disorders

Study Plan Lessons

12 Points to Answering Pharmacology Questions
Care of the Pediatric Patient
Menstrual Cycle
54 Common Medication Prefixes and Suffixes
Advance Directives
Family Planning & Contraception
Vitals (VS) and Assessment
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Epidemiology
Essential NCLEX Meds by Class
Growth & Development – Infants
6 Rights of Medication Administration
Growth & Development – Toddlers
Health Promotion & Disease Prevention
Growth & Development – Preschoolers
Growth & Development – School Age- Adolescent
Legal Considerations
HIPAA
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
Anxiety
Basics of Calculations
Brief CPR (Cardiopulmonary Resuscitation) Overview
Cultural Care
Gestation & Nägele’s Rule: Estimating Due Dates
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Environmental Health
Fire and Electrical Safety
Generalized Anxiety Disorder
Gravidity and Parity (G&Ps, GTPAL)
Impetigo
Oral Medications
Pediculosis Capitis
Post-Traumatic Stress Disorder (PTSD)
Burn Injuries
Fundal Height Assessment for Nurses
Injectable Medications
Somatoform
Technology & Informatics
Fall and Injury Prevention
IV Infusions (Solutions)
Maternal Risk Factors
Complex Calculations (Dosage Calculations/Med Math)
Mood Disorders (Bipolar)
Depression
Isolation Precaution Types (PPE)
Paranoid Disorders
Personality Disorders
Cognitive Impairment Disorders
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Alcohol Withdrawal (Addiction)
Grief and Loss
Suicidal Behavior
Physiological Changes
Sickle Cell Anemia
Discomforts of Pregnancy
Antepartum Testing
Hemophilia
Nutrition in Pregnancy
Communicable Diseases
Disasters & Bioterrorism
Maslow’s Hierarchy of Needs in Nursing
Benzodiazepines
Delegation
Nephroblastoma
Prioritization
Chorioamnionitis
Triage
Gestational Diabetes (GDM)
Disseminated Intravascular Coagulation (DIC)
Ectopic Pregnancy
Hydatidiform Mole (Molar pregnancy)
Gestational HTN (Hypertension)
Infections in Pregnancy
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Fever
Overview of the Nursing Process
Dehydration
Fetal Development
Fetal Environment
Fetal Circulation
Process of Labor
Vomiting
Pediatric Gastrointestinal Dysfunction – Diarrhea
Mechanisms of Labor
Therapeutic Communication
Defense Mechanisms
Leopold Maneuvers
Celiac Disease
Fetal Heart Monitoring (FHM)
Appendicitis
Intussusception
Abuse
Constipation and Encopresis (Incontinence)
Patient Positioning
Complications of Immobility
Conjunctivitis
Prolapsed Umbilical Cord
Acute Otitis Media (AOM)
Placenta Previa
Abruptio Placentae (Placental abruption)
Tonsillitis
Preterm Labor
Urinary Elimination
Bowel Elimination
Precipitous Labor
Dystocia
Pain and Nonpharmacological Comfort Measures
Hygiene
Overview of Developmental Theories
Postpartum Physiological Maternal Changes
Bronchiolitis and Respiratory Syncytial Virus (RSV)
MAOIs
Postpartum Discomforts
Breastfeeding
Asthma
SSRIs
Cystic Fibrosis (CF)
TCAs
Congenital Heart Defects (CHD)
Intake and Output (I&O)
Defects of Increased Pulmonary Blood Flow
Blood Glucose Monitoring
Postpartum Hemorrhage (PPH)
Defects of Decreased Pulmonary Blood Flow
Mastitis
Insulin
Obstructive Heart (Cardiac) Defects
Mixed (Cardiac) Heart Defects
Specialty Diets (Nutrition)
Enteral & Parenteral Nutrition (Diet, TPN)
Histamine 1 Receptor Blockers
Initial Care of the Newborn (APGAR)
Nephrotic Syndrome
Enuresis
Newborn Physical Exam
Body System Assessments
Histamine 2 Receptor Blockers
Newborn Reflexes
Babies by Term
Cerebral Palsy (CP)
Renin Angiotensin Aldosterone System
Head to Toe Nursing Assessment (Physical Exam)
Head to Toe Nursing Assessment (Physical Exam)
Meconium Aspiration
Meningitis
Transient Tachypnea of Newborn
Hyperbilirubinemia (Jaundice)
Spina Bifida – Neural Tube Defect (NTD)
ACE (angiotensin-converting enzyme) Inhibitors
Autism Spectrum Disorders
Attention Deficit Hyperactivity Disorder (ADHD)
Newborn of HIV+ Mother
Angiotensin Receptor Blockers
Calcium Channel Blockers
Cardiac Glycosides
Scoliosis
Metronidazole (Flagyl) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Vancomycin (Vancocin) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Atypical Antipsychotics
Rubeola – Measles
Mumps
Varicella – Chickenpox
Pertussis – Whooping Cough
Autonomic Nervous System (ANS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Parasympathomimetics (Cholinergics) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Epoetin Alfa
HMG-CoA Reductase Inhibitors (Statins)
Magnesium Sulfate
NSAIDs
Corticosteroids
Hydralazine (Apresoline) Nursing Considerations
Nitro Compounds
Vasopressin
Dissociative Disorders
Eczema
Proton Pump Inhibitors
Schizophrenia