Making Prioritizing a Priority

As students, it is super easy for you to focus on tasks and not see “the big picture.” And no worries, that’s exactly what’s expected of you. But, in order to make the successful transition into new graduate RN you’ll need to start thinking more globally…here’s some tips.

I always advocate new nurses come up with a schedule for the day…my daily schedules as a student were insane…seriously down to 5 minute blocks. As I gained more experience, my schedules became looser and by the time I started working as an RN the schedule listed what I needed to do each hour. These days I go off more of a “to-do” list, but those early days of actually scheduling out my time were invaluable.

With that said, a schedule doesn’t mean you can throw prioritizing out the window…while a schedule will help you with your time management, prioritizing is a dynamic activity that takes place continually throughout your day. And yes, many times, prioritizing means re-thinking your schedule as you go, making adjustments and acting accordingly.

Things to consider as you prioritize throughout your day:
– who is your most critical patient?
– how long will a specific task take?
– what is the most important piece of data you need right now?
– are  you prepared for the unexpected?
– what are your patient’s needs, what will serve them the best?

Who is your most critical patient?
The thing about this question, is that it can change throughout the day. Just because patient A starts off as your sickest patient, doesn’t mean things will stay that way. Maybe patient A will stabilize and patient B will start showing signs of respiratory failure…now, who’s your most critical patient? Understanding that you may need to adjust your focus based on changes in patient condition is imperative to being a good nurse.

How long will a specific task take?
Considering how long a task will take vs other things you need to do will help you keep the most amount of time available for the most important tasks. Let’s say your patient is sitting in the chair and wants to get back to bed…you know it’s going to be a group project and will likely take a while. In the meantime, your other patient is on an insulin gtt and needs a blood sugar taken every hour otherwise they might get more insulin than they need which would be extremely dangerous. It is OK to tell your chair patient, “I need to go take care of one quick thing, then I’ll bring someone to help me get you back to bed.” Not getting bogged down in time-consuming tasks when essential things MUST get done is a key to effective prioritizing.

What is the most important piece of data you need right now?
This will vary depending on what is going on with your patient. Let’s say you have a fresh craniotomy patient and a patient on a vent. Your orders indicate you are to do hourly neuro checks on your crani patient, and your patient on the vent needs a daily blood gas. Considering that neuro changes can occur very quickly, you’d want to conduct your neuro check first…the blood gas, though important, is a daily task and can probably wait the 5 minutes you need to conduct a neuro assessment on your more critical patient. If your patient is on pressors, you want to know their blood pressure at all times…if he’s in renal failure, you’ll be eying his urine output like a hawk. Knowing what key data you need at any given time will help you prioritize what needs to be done/assessed in relation to everything else you have going on.

Are you prepared for the unexpected?
Knowing what potential crisis could occur, can make you keen to what your priorities for the day are and help you be prepared. For example, knowing that your patient presented to the ED in complete heart block and that your other patient is at huge risk for cerebral vasospasm put you in the mindset of being ready for (and assessing appropriately for) any disasters coming your way. I always start my shift with a little “what if”…and a plan for what I can do to prevent it and react to it.

What are your patient’s needs and what will serve them best?
Each patient will need different things based on their pathophysiological process. Knowing what these needs and priorities are will help you keep the most important things at the forefront. For example, let’s say you have a septic patient whose K is 3.3, Mg is 1.8 and has multiple IV meds due at 0900…vanco, potassium, magnesium and a banana bag. You’ve only got one available IV site (your other two sites are being hogged by an insulin gtt and bicarb gtt)…what meds are you going to give first? Remember he’s septic, so you’re going to give the antibiotics first every single time. If his K were 2.6 and he were having ectopy, you’d need to either give it PO or start another line….sometimes prioritizing means doing two things at once. I’ve always said I’d be Super Nurse if only I had three hands 😉

Oliver loves nurses who make his cat treats a priority.

I hope that helps you get an idea of how to get into the mindset of prioritizing and re-prioritizing continually throughout the shift. Soon it will become second nature!

Be safe out there!

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