Who Do You See First? Prioritization Trainer
Read a quick shift report on four clients, pick who you see first, then check the reasoning: ABCs, Maslow, acute vs chronic, unstable vs stable, actual vs potential, safety and expected vs unexpected. Delegation practice included.
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Try it 7 days for $1How to prioritize
NCLEX and nursing school questions ask which client is in the most danger if you wait. Use these frameworks in order: ABCs first, then the rest of Maslow, and use the others to break ties.
ABCs
Airway first, then breathing, then circulation. A blocked or swelling airway beats a breathing problem, and a breathing problem beats a circulation problem. (In CPR for cardiac arrest, current guidelines use C-A-B, but for prioritizing clients who are awake and breathing, think A-B-C.)
Maslow
Physiological needs first (oxygen, circulation, fluids, nutrition, elimination, pain), then safety and security, then love and belonging, then self-esteem. Psychosocial needs wait unless they threaten safety, such as suicide risk.
Acute vs chronic
A new or sudden problem comes before a long-standing one the body has adapted to.
Unstable vs stable
A client whose vital signs, level of consciousness or condition is changing or getting worse comes before a client who is stable or improving.
Actual vs potential
A problem that is happening now comes before a risk that has not happened yet.
Safety
Protect the client and others from immediate harm: falls, self-harm, violence, aspiration, wrong treatment. Physical safety follows the ABCs and other physiological needs on Maslow's pyramid.
Expected vs unexpected
A finding that fits the client's condition or procedure (expected) can usually wait. A finding that does not fit (unexpected) needs you now.
3 memory tricks
- Ask: new, worse or unexpected? If yes, that client moves up the list. If the finding is old, stable or expected for the condition, that client moves down.
- ABC, then Maslow, then the rest. Airway, breathing, circulation; then other physiological needs; then safety; then psychosocial needs and teaching.
- The RN keeps EAT, plus anyone unstable. Evaluate, Assess, Teach. Stable, routine, predictable tasks can go to the UAP. The LPN can care for stable clients with predictable outcomes and reinforce teaching the RN started.
Test-taking tip: look for the one client who will be harmed most by waiting. If a finding is expected for the condition (a COPD client at an SpO2 of 90%), that client can usually wait.
Written by Anna Curran, RN, BSN, PHN. For study only. Your clinical judgment, your facility’s policies and your instructor come first. Scope of practice for the LPN and UAP varies by state and facility.