Depending on what kind of unit you work on, I would think the most important tasks to get out of the way first would be checking the patients charts for new orders, checking the labs to see if you have to report any abnormal values, and checking the patients med sheets to see what meds are due, and what supplies you will need to give them. After doing this, check the vital signs of each of your patients to ensure they are within normal limits. If not, call the abnormal values to the doc to see if there are additional meds or treatments required to stabilize the patients vital signs, etc.
Assess your patients after doing all of the above. Now this list sounds perfect in black and white and on "paper"...
The REALITY of nursing is call lights go off, patients crash or yell they are in pain and want their pain med NOW, docs call, the unit clerks are constantly ringing the dang phone nurses must carry around with them all shift, and shift managers are screaming about acuities being entered, the board being updated, and the nurse educator is reminding everyone about the competencies that must be addressed by a certain date.
Now, we move from what the unit staff is requiring of you to what the patient's family members are requiring of you. Then there is transport calling or in your face to take a patient on your list somewhere, or dietary, or physical therapy, or respiratory, or.......... Get my drift!
In lieu of all the drama that occurs during a shift's work, it is EXTREMELY important for a nurse to block out all "noise" and FOCUS, FOCUS, FOCUS on providing the safest care possible to the patients assigned for that shift. The only way this can be done is to STAY in control of your assignment. It's up to YOU to remind those demanding your attention that there is only ONE you, and unfortunately....like at a doctor's office...only ONE patient at a time can receive your full attention, therefore the others will have to wait their turn. DON'T LOSE SIGHT OF THIS VERY IMPORTANT INFORMATION EITHER because your license depends on it! :kiss