How do you define "Prioritization"?

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Before nursing, "prioritization" to me meant figuring out what needs to be done first, second, and third with the assumption that the point was to get the most important things done first but that there would be enough time to get everything done eventually. However, in many situations, the reality is that the person CAN'T get everything done in the time allotted. Thus priorizing ensures that the MOST IMPORTANT things get done at all, not just that they get done before other things... because you might run out of time.

I say this because it seems we often hear the advice "prioritize" when someone is asking how to get more done or to work faster. But no matter how well you prioritize, there is still just as much to do and it will still take as much to do everything. Yes, you can learn to bunch certain tasks together for efficiency, but that's not prioritizing, that's being more efficient. You can learn to do certain things faster (assess a patient, hang an IV), but again that's not prioritizing, that's learning how to do things faster (which often comes with experience, which takes time to build up).

Prioritizing ensures that medications get given even if the linen change gets put off. Prioritizing ensures that the unstable patient gets assessed frequently even if another patient never gets the coffee they wanted. Of course, the nurse should make sure the linen gets changed and the patients' requests get taken care of, but not at the cost of patient safety. THAT to me is "prioritization."

In nursingspeak, however, "prioritization" and "time management" often seem to be the catch-all words for the speed and judgement that can only be gained through experience that allows for nurses to get more done than seems humanly possible if you break it down task by task.

Thoughts?

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Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Setting priorities means the same thing that it always has. There are some things that can wait until the next shift. Although the oncoming nurse might not see it that way.

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Specializes in ER, ICU, Infusion, peds, informatics.

they go together, but are separate ideas, and sometimes they conflict.

"prioritization" means to me "what needs to be done now, over other things?"

if i have five people waiting to be triaged in the waiting room, i'm going to take the 65 yo with chest pain over the 18 yo with knee pain, even if the 18 yo got there first.

if my assessment reveals potential cardiac chest pain, i'm going to do an ekg and start labs, possibly give anti htns, asa, etc, even if the waiting room is backing up.

if my assessemnt reveals potential pneumonia chest pain, i'm goign to start labs, give abx, and get a cxr (and probably the ekg, too) even if the waiting room is backing up.

to me, prioritization is more important than time management, and it can be difficult to learn when to saccrifice time management for prioritization.

time management encompasses other things, such as delegation.

if things are really getting backed up for me, i can try to get a tech to do the ekg/lab work while i move on. i need to make sure everything was done, but i don't have to always do it myself.

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To me it is figuring out what is the most crutial and needs to be done first et foremost and then on down the line.

Leslie

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Specializes in Telemetry/Med Surg.

Also consider delegation

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my thoughts exactally

also consider delegation
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I define prioritization in our field as who and what needs to be addressed first. unfortunately management sees it as answering call bells, even if if means dragging you out of another patient's room to move a pitcher of water closer . Believe me this has happened. Healthcare is not about health anymore it is about customer service. We were told on our unit that we were doing fine in the surveys with our care, teaching, i forming the patient about their care. BUT WE DIDN'T SMILE ENOUGH! :uhoh3:

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At the change of shift, I got a cardiac arrest patient. The arrest was witnessed and paramedics arrived on the scene about 4 minutes after the patient went down. The patient came to us intubated and with a nice 18g IV to the left EJ. Without a clear history, we weren't sure of what caused the arrest.

Anyway...

In an effort to "quickly" figure out what to do next, the doc asked for an iSTAT to be run (basic chems + H/H... takes 2 minutes to complete). I handed off the blood to one of our ED techs who happened to walk by the room and told him that I need this immediately.

5 minutes later we wondered where those results were. Nothing was on the iSTAT machine, and the tech was nowhere to be found. When he finally appeared, I asked him where the results were. He said that he was doing an EKG and that the machine was now "cookin'." In other words, he got sidetracked and forgot.

After the code was terminated (and the patient expired), I yelled at the tech for failing to prioritize correctly. He saw the intubation box, the crash cart, and coworkers doing CPR on a patient. The tech's excuse was "I'm not the only one who knows how to use an iSTAT machine. You have 7 other nurses and 3 techs around, and I had to do an EKG."

My thinking was... if that had been ME in HIS position, I would have started the iSTAT machine, brought the small little machine over to where the code was occurring, and then prance over to do the EKG.

Instead, we wound up with a hemolyzed sample and screwy results because the blood had been sitting around for so long before it was run.

Was I wrong in getting upset with this tech? Maybe I should just do everything myself from here on out... :devil:

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My thinking was... if that had been ME in HIS position, I would have started the iSTAT machine, brought the small little machine over to where the code was occurring, and then prance over to do the EKG.

Was I wrong in getting upset with this tech? Maybe I should just do everything myself from here on out... :devil:

Wrong to be upset? In this case, I don't think so. Upset at the situation, definitely. At the person? Well, either he will learn from the situation, ultimately a good thing. No one is born knowing everything, so what's the point of being upset that the person didn't inherently know what to do? Or perhaps, he isn't a good fit for the job, and will continue to use poor judgement. Then the best thing is having them removed from the job. Being upset at them won't make the person better at their job one way or another.

I guess my gripe is when say the aid DOES the blood tests first based on prioritization and then gets scolded by someone else for not getting the EKG done faster. And when the aid says "the blood tests took priority" then the scolder says "of course, but you should be able to manage your time better and be able to get both done!"

My experience would be putting patient assessments and medications first as a newbie and then getting scolded for not getting other things done (eg staying late to chart). With the pressure to get everything done with so many competing demands, mis-prioritization will happen at times and then I'd get scolded for poor judgement. To me, it felt like damned if you do and damned if you don't, and if you can't get it all done quickly and correctly 9 out of 10 times, then you should just get out of way because you clearly can't cut it.

I certainly never heard "It's okay that this or that wasn't done because you're new and aren't as quick and what's more important is that you took care of these other more important things." All I'd hear is what I did wrong, what was too slow, what was poor judgement. When things went more smoothly, I had to wonder if it was just that no one noticed what I'd missed or if I had made some good choices.

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Specializes in Hospital Education Coordinator.

You can always depend on Maslow's heirarchy of needs to help you prioritize. Then document accordingly. I remember as a new nurse I was trying to be everything to everybody. Then one day I overheard a seasoned nurse being asked to get a snack for a patient. She replied "No. I will be making rounds again in another hour or so and will see if you are still hungry by then" The patient did not appear to be offended because the nurse's attitude was not haughty or bitter. Just matter of fact, "no". I have learned to say no sometimes.

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You can always depend on Maslow's heirarchy of needs to help you prioritize. Then document accordingly. I remember as a new nurse I was trying to be everything to everybody. Then one day I overheard a seasoned nurse being asked to get a snack for a patient. She replied "No. I will be making rounds again in another hour or so and will see if you are still hungry by then" The patient did not appear to be offended because the nurse's attitude was not haughty or bitter. Just matter of fact, "no". I have learned to say no sometimes.

Good point!

However, it gets more tricky when the competing demands are neither immediately life threatening nor something that can be put off indefinitely. What do you do first, second, third, etc, knowing that you might not get to everything? Do you prep the patient who has got a test scheduled in an hour? You don't want to put that off too long or next thing know transport will be there and the patient won't be ready. Do you administer the morning insulins? Let's assume the patients patients don't have any signs of distress, but breakfast will be delivered soon and you want that done by then. Do you change out the PCA that's almost empty, knowing that you're going to get busy and wanting to avoid the patient ending up without any pain meds if you can't get to it when it does run out? Maybe there are some antihypertensives on the MAR, and you want to make sure those get administered in a timely manner. And let's say there are also a slew of new orders to review. Can't put that off too long, either. You have to at least quickly look through them to see if there are any stat orders which you'll have to try squeeze in as well.

Yikes!

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