Mastering prioritization skills?

[amzyRN]

Priority setting is the most challenging thing to me as a new nurse. I get priority setting in critical situations (I have the ABCs down), but there are subtleties that I sometimes miss. If two meds are due, which one is the priority if one has to be late? When you have to get a patient down to CT but also have to pass meds, who can wait if you are unable to delegate? I usually rush the patients with brain bleeds and possible PEs, but will sometimes wait on a CT abdomen and pelvis unless it's a stat order. How do you decide?

Today, I had to choose between hanging an antibiotic late or hanging potassium because of compatibility issues, so I hung the potassium first and was late on the antibiotic. But the potassium wasn't critically low and the patient was admitted for pneumonia. But the antibiotic need to go over 4 hours and the potassium would take 2, so I hung the potassium first. The patient also had an incompatible antibiotic going in through a second line. I think I prioritized correctly. Maybe I should have gotten a third IV site, or a PICC though. I have been late on meds more than a few times and have felt bad after, like I had really missed something and I don't want to miss anything. I've also missed when IVs are due to be changed several times and have often overlooked this.

Are there any hard and fast rules that you more experienced nurses have to master priority setting? Is it just a skill that is learned over the course of your practice? Can you give me some tips or point me in the right direction for getting better at this. I really want to be an excellent nurse who has this down pat.

[nurseprnRN, BSN, RN]

Identify someone on your floor who can be a mentor to you, someone you can go to and say, "I've never encountered this situation before and this is what I thought about it. What do you think?" You can learn a lot from that.

[HouTx, BSN, MSN, EdD]

For a new nurse, I think you're actually doing quite well. You've analyzed your situation and determined the best way to improve..... Way to Critically Think!!!

There's no 'easy' solution when you have conflicting events occurring at the same time. What is the staffing model in your department? Is there a possibility that you could ask a co-worker to help out - - -"Joe, I have to take Mr X to CT but I have an abx due in 15 min on Mrs Y - If I leave it set up and ready to go, can you start it for me in 15 minutes? I will do the same for you next time"

Patient care is a team sport. No one ever ran a code by her/himself. The key is to make sure you reciprocate - return those favors by picking up the slack for that co-worker when he needs it.