PRIORITIZATION

The nurse is responsible for prioritizing and individualizing a client’s plan of care. Prioritization is defined as “deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent” (Silvestri, 2004, p. 65). The RN must identify problems, formulate interventions to address those problems, and prioritize interventions that must be accomplished quickly to achieve optimum client outcomes. However, planning care that is prioritized, individualized, and comprehensive can be challenging due to lack of time and lack of adequate resources. Hansten and Jackson (2004) identify criteria for evaluating and weighing tasks or processes to be prioritized:

Three levels of priority setting (Alfaro-Lefevre, 2004) also aid the nurse in prioritizing nursing care:

A fourth level, Maslow’s hierarchy of needs, spans the continuum of the most crucial needs necessary for survival to self-actualization and can also be used to aid in priority setting. Physiological needs, necessary for the continued function of the human body, often require the greatest attention when prioritizing client care. However, attention to safety needs such as the prevention of accidents and adverse client outcomes must be considered a high priority as long as the client’s physiological needs have been stabilized.

DELEGATION

Both the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) define delegation as “the process for a nurse to direct another person to perform nursing tasks and activities” (ANA and NCSBN, 2005, p. 1). Nurses responsible for delegation must be aware of many variables aside from the client’s condition. To safely and appropriately delegate nursing care, the nurse must have an understanding of the appropriate state’s Nurse Practice Act, which identifies which tasks may be delegated, when the tasks may be delegated, and to whom the tasks may be delegated.

The first step in the delegation process is the assessment of the client. In addition, to safely delegate, the nurse must assess the qualifications of each member of the health care delivery team. Once the nurse determines the client’s condition and the tasks to be delegated, the nurse then identifies the team member to whom the task will be delegated based on an understanding of their qualifications and skills. Once the tasks to be delegated are determined, the nurse must communicate the actions to the delegate, including what to do, when to do it, and to whom it should be done. Delegates should also be informed of the circumstances under which they should ask for assistance. Clear communication is critical, so that delegates have a complete understanding of the delegated task, as well as of the conditions that require the assistance of an RN. The Five Rights of Delegation (ANA and NCSBN, 2005) summarize the process and include the following:

While the RN is responsible for the safe delegation of nursing tasks to the appropriate team member, responsibility and accountability for the safe completion of interventions are not delegated and remain the ultimate responsibility of the RN. The nurse must monitor the implementation of the task and determine whether the task was completed appropriately and in a timely manner. After completion of delegated tasks, the nurse must evaluate both the delegation process and client outcomes. Questions that should be answered in evaluating this process include the following:

The algorithm on the facing page may be used to assist the nurse in the delegation process (Fig. 1-1):

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