Week 3: Prioritization Discussion Case Study

Review the following Prioritization Principles videos:

1. Prioritization

1. Nursing Leadership – ABCDE Principle and Patient Prioritization

1. Nursing Leadership – Efficient Nursing Practice & Delegation

Maslows Hierarchy of Needs as it relates to Prioritization

Introduction:

• Setting priorities is an essential and critical thinking skill.
• Priority setting is perhaps the most critical skill in good time management, because all actions we take have some type of relative importance.
• Management of a patient load depends heavily on setting priorities.
• Generally, the new nurse tends to focus on one problem at a time rather than seeing the whole picture and may have difficulty in priority setting.
• Through the assessment process, patients help the nurse define their needs, establish interventions, and implement the plan of care. This is where individualized priority-setting between patients and nurses occurs.
• By necessity some care needs will be delayed in preference to more pressing needs of other patients.
• Priorities will be influenced by the acuity of the patients condition and the acuity of all patients assigned to a nurse

Time Management:

• Three Basic Steps in Time Management
  • Allow time for planning and establish priorities.
  • Complete the highest priority task whenever possible, and finish one task before beginning another.
  • Reprioritize based on the remaining tasks and on new information that may have been received.

Priority ranking of patients:

• First level patient problem
  • These are threats to a patients immediate survival or safety and demand immediate nursing intervention. ABCs (airway, breathing, circulation).
• Second level patient problem
  • Concerns such things as mental status change, acute pain, acute urinary elimination, untreated medical problems requiring immediate attention (diabetic needing insulin) abnormal pathology lab results, risks of infection, safety, or security.
• Third level patient problem
  • Those that do not fit into the above two categories such as monitoring for medication side effects, lack of patient knowledge, longer patient longer-term problems with living activities, etc.
• No life-threatening problems exist
  • The nurse used both professional judgment and the patient to set priorities and determine planning.
  • This is a continually changing aspect of assessment of patients.

Priority Setting Traps:

Whatever hits first

• This trap occurs when an individual simply responds to things as they happen rather than thinking first and then acting. This is common to new nurses.
• Path of least resistance
  • In this trap the individual makes the assumption that it is easier to do a task by himself or herself and fails to delegate appropriately.
• Squeaky wheel
  • In this trap, the individual falls prey to those who are most vocal about their requests and then feels a need to respond to the time frame imposed by the squeaky wheel rather than his or her own.
• Default
  • The individual feels obligated to take on tasks that no one else has come forward to do.
• Inspiration
  • In this trap, individuals wait until they become inspired to accomplish a task. Some tasks will never be inspiring, and the wise time manager recognizes that the only thing that will complete these tasks is hard work and appropriate attention to the matter.

Managing time at work:

• Being overwhelmed by work and time constraints lead to increased errors, omission of important tasks, and general feelings of stress and ineffectiveness.
• Time management skills are learned although some people are better at it than others.
• Disorganization results from poor planning and prioritization.
• Simple suggestions for time management:
  • Gather all the supplies and equipment that will be needed before starting an activity. Breaking down a job mentally into parts before beginning the activity may help the nurse identify what supplies are needed.
  • Group or cluster activities that are in the same location. If you have walked a long distance down a hallway, attempt to do several things there before going back to the nurses station. Another example is a home health nurse, group client visits geographically when possible to minimize travel time.
  • Document your nursing interventions as soon as possible after an activity is completed. Waiting until the end of the workday to complete necessary documentation increases the risk of inaccuracies and incomplete documentation.
  • Strive to end the workday on time. Although this is not always possible, delegating appropriately to others and making sure that the workload goal for any given day is reasonable are two strategies that will help accomplish this goal.
  • Schedule difficult tasks during the period of the day you are most productive and simpler, more routine tasks during less productive times.

Time wasters:

• Procrastination
  • The three most common reasons for procrastination are:
    • Not wanting to begin
    • Not knowing where to begin
    • Not knowing where to begin, even if you wanted to do, which you dont.
    • Poor planning
    • Failure to establish goals and objectives
    • Inability to delegate
    • Inability to say no
    • Management by crisis
    • Haste
    • Indecisiveness

Coping with short short-staffing:

• Prioritize you assignments
• Organize your workload
• Be a team player
  • Make a rule that no one can sit until everyone can sit. Pitch in and help others.
• Use unlicensed personnel wisely
• Encourage family participation
• Inform and involve nursing administration
• Communicate effectively and nicely
• Take care of yourself
• Maintain a positive attitude
  • Attitude is everything. If you go into a is challenging situation with a positive attitude you can achieve great results. A negative attitude can bring down the morale and performance of the entire team.

Scenario:

Assume that you are the Charge Nurse of a team with one LPN and one nursing assistant on the 7A-3P shift at an acute care hospital. The three of you are responsible for providing total care to 10 patients. Prioritize the following list of 10 things you need to accomplish this morning. Use a 1 for the first thing you will do and a 10 for the last.

________

Check MAR against the orders

________

Listen to night shift report from 0700-0720

________

Perform walking rounds to assess the night shift report and to introduce yourself to patients.

________

Hang four (4) 0900 IV medications

________

Set up the schedule for breaks and lunch among your team members

________

Give the 0845 pre-op on patient going to surgery at 0900

________

Pass the 0830 breakfast trays

________

Read the charts on new admissions that you are responsible for on the unit

________

Check 0600 blood glucose results for 0730 insulin administration

________

Consult with the interdisciplinary healthcare team to develop and/or revise patient plans of care

Now, create an initial discussion posting that provides the rationale for how your prioritized your day in relation to Maslows Hierarchy of Needs. Your initial posting must be completed by Wednesday, 3/17/2021 by 11:59 pm. On another day, you must respond to two of your classmates by Sunday, March 21/2021 by 11:59 pm.

References: 

Hgg-Martinell, A., Hult, H., Henriksson, P., & Kiessling, A. (2020). Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care – An Ethnographic Study. Advances in medical education and practice, 11, 2130. https://doi.org/10.2147/AMEP.S230476

Toney-Butler TJ, Thayer JM. Nursing Process. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. [Figure, Maslow’s Hierarchy of Needs for…] Available from: https://www.ncbi.nlm.nih.gov/books/NBK499937/figure/article-26037.image.f1/