Establishing Priorities in the Clinical Setting

Priority
Something that is more important than anything else at a given time
Setting priorities is “unique” to each client or situation
Priority setting is a complex critical thinking skill
A nurse needs to be able to set priorities for an individual client or
group of clients
Must continually monitor clients for changing circumstances, thus
priorities may change as shift progresses

Maslow’s Heirarchy of Needs

Self-Actualization
Growth, accomplishing goals, autonomy
Self-Esteem
Self-worth, self-respect, dignity, need for privacy and independence
Love and Belonging
Affection, intimacy, support, affiliation
Safety and Security
Protection and stability, physiological or psychological threats to
feeling secure
Physiological
Air, food, water, temperature, elimination, rest and comfort, sex,
activity, physical comfort, pain avoidance

Craven and Hirnle (2003) model organized priorities into 3 categories

to include:
High Priority Situations
Medium Priority Situations
Low Priority Situations

HIGH PRIORITY SITUATIONS

Life threatening events
Airway difficulties, inability to clear airway, risk for aspiration, gas
exchange disorders
Cardiovascular changes such as hemorrhages, alterations in cardiac
output, tissue perfusion changes, alterations in fluid volumes
Unstable client
Change in client conditon that could become life-threatenting
Mental status changes
Risk for violence
High Priority (Life Threatening)
Impaired spontaneous ventilation
Ineffective cerebral tissue perfusion
Decreased cardiac output
MEDIUM PRIORITY SITUATIONS
Non-emergent problems that could result in unhealthy consequences
physically or emotionally, but not likely to threaten life
Anxiety, education, scheduled tests or appointments
Confusion, acute urinary elimination, pain
Risk for injury, risk for infection
Medium Priority (Unhealthy Consequences)
Impaired wheelchair transfer ability
Acute confusion
Ineffective protection
LOW PRIORITY SITUATIONS
Problems that can usually be resolved easily with minimal
interventions and have little potential to cause significant
dysfunction
Self-care deficit
Family coping
Powerlessness
Low Priority (Makes no difference if not attended to this day)
Delayed growth and development
Spiritual distress
Risk for low self -esteem

General Guidelines
Assess client and situation obtaining all necessary data
Health history, physical exam, evaluating lab and diagnostic results,
talking to client, making observations, collaborating with
colleagues
The complexity of each client situation is taken into account looking at
4 guidelines to include:
Is it a life threatening concern?
Is it a safety concern?
Client priorities?
Nursing priorities?

Multitasking
Setting priorities is not linear
Several needs or concerns are frequently addressed simultaneously
Multitasking is important in time management
Once again, consider:
1) Is it immediately life threatening?
2) Is client safety being affected?
3) What are the client’s priorities?
4) What are the nurse’s priorities?
The nurse looks at client strengths and health concerns; moral
and ethical issues; the resources, setting and time available;
and heirarchy of needs
Pittfalls in Priority Setting
Inadequate assessment and evaluation of client needs
Failure to differentiate between priority and non-priority tasks
Acceptance of others priorities without assessing all variables
Performance of tasks with a “first-identified/first-completed” approach
Completion of easiest task first

Key Points
Critical thinking is inherent in priority setting
Priority setting includes effective time management
Client needs must be identified to establish nursing care priorities
Maslow’s Heirarchy of Needs can be used to establish client priorities
Prioritize nursing diagnoses using high, medium, and low priorities
Divide nursing activities into 4 levels of priority: life threatening,
safety, client priorities, and nursing priorities
Assessing precedes prioritizing – sort your data into clusters
Identify client needs and formulate nursing diagnoses, then determine
which activities will be priority
Care is directed toward establishing client goals and expected
outcomes
Ongoing evaluation necessary to ensure quality of care is delivered