Prioritizing nursing care involves identifying the most urgent and essential needs of patients and allocating resources and attention accordingly. The prioritization process ensures that patients receive timely and appropriate care based on their individual conditions and the severity of their health issues. While not every situation is the same, in general, these are ways to help you decide whom to care for first.

1. ABCs: Assess and address airway, breathing, and circulation (ABCs) first. These are the fundamental physiological needs that are critical for a patient’s survival. For example, if a patient is experiencing difficulty breathing or has an obstructed airway, immediate intervention is necessary.
2. Life-threatening conditions: Attend to patients with life-threatening conditions, such as severe bleeding, cardiac arrest, or acute respiratory distress, as these require immediate interventions and stabilization.
3. Pain management: Address patients’ pain promptly, as uncontrolled pain can negatively impact their overall well-being and hinder recovery.
4. Unstable vital signs: Prioritize patients with unstable vital signs, such as low blood pressure, high heart rate, or abnormal temperature. These may indicate a deterioration in the patient’s condition and require urgent attention.
5. Changes in neurological status: Patients with altered mental status, sudden confusion, or neurological deficits should be evaluated promptly, as these changes may indicate an underlying neurological emergency.
6. Risk of harm: Assess and address patients at risk of harm, such as those at risk of falls, pressure ulcers, or medication errors. Implement preventive measures to ensure patient safety.
7. Time-sensitive interventions: Identify and prioritize nursing interventions that have time-sensitive requirements, such as medication administration, wound care, or diagnostic tests with specific timeframes.
8. Collaborative care: Coordinate care and communicate with the healthcare team, including physicians, specialists, and other healthcare professionals. Collaborate to ensure seamless and coordinated care delivery.
9. Ongoing assessments: Continuously reassess patients and update priorities based on changes in their condition. Adjust the plan of care accordingly to address emerging needs.
10. Patient preferences and concerns: Take into account patients’ preferences, concerns, and immediate needs. However, patient preferences will fall last on the list. Engage in effective communication and involve patients in their care decisions whenever possible.

Maslow’s Hierarchy of Needs

Using Maslow’s Hierarchy of Needs is a common way to prioritize who needs to see the nurse first. While there are other methods, these works when patients have specific needs that need to be addressed on an acute care hospital unit. Maslow’s Hierarchy of Needs reflects basic human needs and gradually steps moving toward higher levels of achievement. This hierarchy of needs is traditionally represented as a pyramid with the base of the pyramid serving as essential needs that must be addressed before one can progress to another area of need. 

Maslow has placed physiological needs at the foundational base (bottom) of the pyramid. Physiological needs include oxygen, food, water, sex, sleep, blood and blood flow, and elimination of wastes. This means that physiological needs must be met before the individual can move to the next level, safety. Maslow’s second level is safety needs. Safety needs include things that keep individuals safe from harm. Examples of safety needs would include housing, a safe environment, financial security, being safe physically, and emotional safety. But safety in a healthcare setting would be prevention of falls, decreasing fall risk, or an environment without hazards. Maslow’s third level reflects emotional needs (past emotional safety) such as a sense of belonging. These needs are often reflected in an individual’s relationships with family members and friends. The top two levels of Maslow’s hierarchy include esteem and self-actualization. An example of addressing these needs in a health care setting is helping an individual build self-confidence in performing blood glucose checks that leads to improved self-management of their diabetes.

Remember, prioritization of nursing care may vary depending on the healthcare setting, patient population, and individual patient circumstances. It is crucial to rely on your clinical judgment, knowledge, and experience when making prioritization decisions.

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References

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Dawson, A., Isaacs, D., Jansen, M., Jordens, C., Kerridge, I., Kihlbom, U., … & Skowronski, G. (2020). An ethics framework for making resource allocation decisions within clinical care: Responding to COVID-19. Journal of Bioethical Inquiry, 17, 749-755.

Déry, J., Ruiz, A., Routhier, F., Gagnon, M. P., Côté, A., Ait-Kadi, D., … & Lamontagne, M. E. (2019). Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol. Systematic Reviews, 8(1), 1-7.

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Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396. https://doi.org/10.1037/h0054346