What is priority framework in nursing?

In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of establishing priorities in order to:

• Apply knowledge of pathophysiology when establishing priorities for interventions with multiple clients
• Prioritize the delivery of client care
• Evaluate the plan of care for multiple clients and revise plan of care as needed

Actual needs and problems take priority over wellness, possible risk and health promotion problems and short term acute patient care needs and problems typically take priority over longer term chronic needs.

Applying a Knowledge of Pathophysiology When Establishing Priorities for Interventions with Multiple Clients

As previously mentioned with the “Integrated Process related to the Nursing Process“, priorities are established using a number of methods and frameworks including the ABCs, Maslow's Hierarchy of Needs and the ABCs/MAAUAR method. Knowledge of these frameworks and an in-depth knowledge about pathophysiology facilitate the proper establishment of priorities relating to the interventions that are then provided to individual clients and groups of clients with diverse needs of varying acuity and differing priorities.

The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order.

Maslow's Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority.

Some examples of each of these needs according to Abraham Maslow's Hierarchy of Needs are:

Physical and Biological Needs

• Some physical needs include the need for the ABCs of airway, breathing and cardiovascular function, nutrition, sleep, fluids, hygiene and elimination.

Safety and Psychological Needs

• The psychological or emotional, safety, and security needs include needs like low level stress and anxiety, emotional support, comfort, environmental and medical safety and emotional and physical security.

Love and Belonging

• The love and belonging needs reflect the person's innate need for love, belonging and the acceptance of others including a group.

Self Esteem and Esteem by Others

• All people have a need to be recognized and respected as a valued person by themselves and by others. People have a need self-worth and self-esteem and they need the esteem of others.

Self Actualization

• Self-actualization needs motivate the person to reach their highest level of ability and potential.

The ABCs / MAAUAR method, which was previously detailed, places the ABCs as the highest and greatest priorities which are then followed with the 2nd and 3rd priority level needs.

The 2nd priority needs include MAAUAR which is mental status, acute pain, acute impaired urinary elimination, unresolved and unaddressed needs, abnormal diagnostic test results, and risks. The 3rd level priorities include all concerns and problems addressed with the 2nd level priority needs.

Prioritizing the Delivery of Client Care

The delivery of client care is prioritized as just discussed above.

In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to effectively manage their time; they should avoid unnecessary interruptions, time wasters and helping others when this helping others could potentially jeopardize their own priorities of care.

Evaluating the Plans of Care for Multiple Clients and Revising the Plan of Care as Needed

In addition to providing guidance and direction in terms of nursing care delivery, plans of care, including nursing care plans and other systems like a critical pathway, provide the mechanism with which the outcomes of the care can be measured and evaluated.

Appropriate and effective client care is dependent on the accuracy and appropriateness of the client's plan of care. For this reason, reasessments and updating and revising a plan of care as based on the client's current status is necessary.

RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:

SEE – Management of Care Practice Test Questions

Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.

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Prioritization is essential for nurses. The ability to look at a situation and determine what is most important, what is time-sensitive, what is critical to the desired outcome and ultimately what to do first and next is prioritization. The purpose of this blog is to explore strategies and guidelines behind prioritizing nursing care to assist current and future nurses in this critical thinking process.

Prioritizing Patient Care

The ability of nurses to prioritize patient care is paramount because it largely determines success or failure in delivering quality health care. The consequences of poor nursing prioritization can be severe, but experienced nurses know the rewards of making wise determinations of how to order their time, actions and attention throughout any given day.

Patient care delivery requires prioritization in several different ways. Nurses decide which actions to take regarding the health care of each patient. Nurses are also often required to decide which patient of a substantial caseload they attend to first. 

In some situations and health care settings, nurses have more time to make decisions thoughtfully. In fast-paced environments where complex health conditions may have rapid status changes, prioritizing patient care can be a moment-by-moment series of quick choices. Therefore, it is beneficial for nurses to be well acquainted with general rules and principles for guiding prioritization.

Often called the ABCs of nursing prioritization, these systematic approaches may become second nature to expert nurses and are lifelines for newer nurses who may be less familiar and less comfortable when complex cases inevitably arise.

ABCs of Nursing Prioritization

Perhaps you are looking to enter your second career as a nurse. You may attempt to envision a typical day if you choose to pursue a nursing degree. Imagine you are assigned to care for your very first simulated patient as a student. The patient in the simulation laboratory is gasping for air and has skin that is beginning to turn pale in color with blue undertones. You understand this is an urgent moment, and a nursing faculty member asks what you will do.

The ABCs of nursing prioritization is the starting point for making these decisions. The ABCs are a mnemonic for making it simpler to remember what is most important when you are in these sometimes stressful situations. 

• A stands for airway
• B stands for breathing
• C stands for circulation

Life-threatening circumstances may exist when these ABCs of nursing are involved. If the patient’s airway is not open, they cannot breathe. If the patient’s breathing is shallow, labored or hindered, the lack of oxygen intake may instantly become extremely serious. If the patient is profusely bleeding or circulation is otherwise blocked or impaired, the body tissues may not have the blood flow required to sustain vital organ function. 

As a nurse, your first job is to remember that these ABCs are the highest priority to address in alphabetical order. Maslow’s hierarchy of needs and the nursing process are additional tools for guiding the decisions of prioritization. Next, we will explore these organized approaches to prioritizing patient care. 

Maslow’s Hierarchy of Needs

Current nurses have likely learned about Maslow’s hierarchy of needs. Abraham Maslow noted that humans are motivated to meet certain needs before they can achieve a higher level of needs. In other words, some conditions are foundational and must be met before seeking to have additional needs met. 

Maslow’s hierarchy of needs is visualized as a pyramid. Needs at the bottom of the pyramid are required as prerequisites to meeting needs higher on the pyramid. The categories of needs in Maslow’s theory are as follows (from the bottom of the pyramid to the top of the pyramid):

• Physiological needs
• Safety needs
• Love and belonging needs
• Esteem needs
• Self-actualization 

Using Maslow’s hierarchy of needs as a framework for prioritizing patient care is one step towards improving patient outcomes. When caring for a patient, the priority is to work toward meeting the patient’s physiological needs. These include stabilizing health conditions and ensuring adequate food, water, rest, shelter and clothing. 

Maslow’s hierarchy of needs essentially states that when a person’s physiological needs are met, the person may then become motivated to meet their safety needs. These include areas of life that bring security, such as financial stability, health promotion, disease prevention and environmental safety. Job security and secure housing arrangements are in the category of safety needs.

It’s important to remember that the hierarchy of needs may not translate to a perfectly stepwise process in practice. There may be some overlap from one level to another — for example, a person may desire love and belonging but is still working on their basic safety requirements. But generally speaking, Maslow’s hierarchy shows that once a person’s physiologic and safety needs are met, a person begins to have the motivation to seek love and belonging. 

Nurses may reference Maslow’s hierarchy of needs when advocating for patients, especially when a foundational unmet need prevents a patient from reaching higher levels. For example, patients experiencing a physiologic condition may worry about their job performance or safety because of their health status. Maslow’s hierarchy indicates that physiological needs must be met before safety, safety before love and belonging, love and belonging before esteem and esteem before self-actualization.

The Nursing Process

ABCs of nursing prioritization and Maslow’s hierarchy of needs can be considered while nurses also apply the steps of the nursing process. The nursing process is interconnected and cyclical, and includes the following stages:

• Assessment: the collection of information about the patient’s condition
• Diagnosis: identification of the problem to be addressed
• Planning: determination along with the patient on how to manage the diagnosis
• Implementation: carrying out the plan of care
• Evaluation: assessment of whether implementation has met the goals of the care plan

Nurses using the nursing process begin with assessing a patient, remembering to assess airway, breathing and circulation first. Subjective and objective information is collected through a patient history and physical examination. Then, a nursing diagnosis is made, followed by planning for how to address the diagnosis. Finally, the plan is implemented and evaluated. The care team must then perform regular reassessments to determine patient outcomes, which may necessitate altering the plan.

Family nurse practitioners also use the nursing process. When a family nurse practitioner prescribes pharmacologic therapy for an infection, and the patient returns to the clinic without symptom resolution after treatment, the treatment can be evaluated as ineffective. At this point, the nurse practitioner will reassess the patient, confirm or alter the diagnosis and potentially prescribe an alternative therapeutic regimen. 

If the patient does not take the medication as directed, the implementation phase of the nursing process did not happen as planned. This may require an adjustment to the plan of care. In some states, nurse practitioners have the authority to prescribe medications independently. In other states, nurse practitioners are advocating for full practice authority. In all states, nurse practitioners use the nursing process to organize and prioritize patient care. 

How to Prioritize Care

When prioritizing patient care, it often helps to ask yourself some questions to ensure you make the best decisions. Some questions nurses can consider include:

• If I do not attend to this situation immediately, how will this affect the patient?
• Are there smaller tasks I can complete quickly or delegate safely?
• Which actions will have a substantial impact on a patient’s health condition?
• What can I do alone, and what requires the assistance of another nurse or physician?

It is a high priority to consider what actions will harm a patient if not completed immediately. Patient safety is critical — yours is, too. Consider how to use all available resources to manage time wisely. Nursing is a gratifying career when patients experience quality care, and nursing prioritization is one of the most critical skills for patient satisfaction.

Pathway Forward

Are you looking to become a nurse or wondering how to become a family nurse practitioner? Consider an accelerated BSN program with Marymount University. 

Are you already a BSN-prepared RN and seeking more autonomy in nursing to practice holistic patient care? Consider training to be an FNP online. Marymount University offers an MSN-FNP program, a DNP-FNP program and a post-master’s FNP certificate option.

If you’re interested in becoming an RN or FNP at Marymount, contact one of our admissions advisors to discuss which pathway is right for you. With excellent faculty, 100 percent online coursework, a three-day on-campus residency and complementary clinical placement services, Marymount could be your pathway forward.