Prioritization

[nursinghealth]

Hello:

I am a new grad RPN. I had an interview at a nursing agency recently where they asked me a prioritization question. I was curious how another nurse would answer the same question...

The question is: "You just started your first shift at a new hospital. You have six patients. One of your patients is screaming, two IV alarms are ringing, two call bells are ringing, and one patient is scheduled to receive insulin. In what order do you approach this?"

I indicated the following:

FIRST --> patient who is screaming (could have fallen)

SECOND --> Patient requiring insulin (time sensitive)

THIRD --> Call bells (if it becomes an emergency, they will scream and become priority #1)

FOURTH --> IV alarms

This is a med/surg environment. Your thoughts?

Thanks!

[SnowShoeRN]

I hate these kinds of questions. I never feel like I have enough information and when you walk onto a floor it isn't as if you won't have any time whatsoever to at least figure out a few key facts about your assignment before seeing them.

For example, does the screaming patient have a history of screaming? That is, is he demented or have some other condition that just makes him scream pretty much all day? What type of insulin is the other patient scheduled for? Is it something that can wait 30 minutes or does he need it ASAP for a goofy blood sugar? Are there CNA's around who you could ask to check on the screaming guy, call bells, and IV alarm to find out what's going on? A lot of patients will hit their call bell for really serious stuff and just wait patiently or pass out until someone gets to them. I saw a guy have a huge MI who just hit his call bell because he didn't want to bother anyone. How long have the alarms been going off and what are the patients getting? If someone with a raging infection is decompensating because she hasn't received any antibiotics all day because her site is infiltrated and that's why the pump is alarming, then that's definitely something to be concerned about. Equally so with someone who needs boluses for hypotension (and the RN forgot to unclamp the line) or someone who's getting blood.

I tend to annoy interviewers because I ask them these kinds of follow up questions before providing an answer. The truth is, aside from mass casualties that you walk into, you'll probably never be in a situation where you have all of these things happening with absolutely no context.

I'm actually kind of annoyed at your interviewers right now. I need to calm down, step away and have some lunch. :)

I hope you receive good news re your interview. Best of luck.

[nursinghealth]

I completely agree! The answer depends highly on the context. The only context I would have here is from my research of the patients' charts prior to the shift and report from the previous nurse. I told the interviewer that the context of the patients' illnesses would greatly inform my decision making.

Thank you for validating my thoughts.