Prioritization and Delegation
Who to see first, and who can do what
Who do I see first?
- Airway, Breathing, Circulation (in cardiac arrest: compressions first, C-A-B).
- Acute and unexpected before chronic and expected.
- Unstable before stable; actual problems before potential ones.
- Maslow: physiological needs → safety → love and belonging → esteem → self-actualization.
- Nursing process: assess before acting (unless the situation clearly needs immediate action).
Ask: "What will kill or harm this patient soonest?" A change in level of consciousness, new chest pain, airway noise, or a sudden drop in BP or SpO₂ beats routine care, teaching and paperwork.
Five rights of delegation (NCSBN)
Right task · right circumstance · right person · right directions and communication · right supervision and evaluation. The RN stays accountable for the outcome.
The RN never delegates
Initial assessment, care planning, evaluation, initial teaching, care of unstable patients, nursing judgment. IV push medications, blood transfusion monitoring, and new admissions stay with the RN.
Who can do what (general guide; state rules and facility policy apply)
| Role | Appropriate | Not appropriate |
|---|---|---|
| RN | Assessment, teaching, care plans, unstable or complex patients, IV meds and blood, admissions and discharges | – |
| LPN/LVN | Stable patients with predictable outcomes; oral, SC, IM meds; dressing changes; tube feedings; data collection; reinforce teaching; urinary catheters | Initial assessment, care planning, new teaching, unstable patients (IV tasks vary by state) |
| Assistive personnel (UAP, CNA) | ADLs, bathing, feeding (no swallowing issues), ambulation, turning, vital signs on stable patients, I&O, weights, specimen collection, bed making, point-of-care glucose (per facility) | Assessment, teaching, medications, judging what a finding means, care of unstable patients |
Disaster triage (START)
| Red: immediate | Life-threatening but survivable with quick care (airway problem, shock, RR >30) |
| Yellow: delayed | Serious but can wait (fractures without shock) |
| Green: minor | "Walking wounded" |
| Black: expectant | Dead or not expected to survive with available resources |
To free beds in a disaster, discharge the most stable patients first.
Handoff: SBAR
Situation (what's happening now) · Background (history, relevant data) · Assessment (what you think the problem is) · Recommendation (what you need). Read back verbal and phone orders.