Nursing Prioritization: A Quick Guide for Beginners
How do you decide what to do first when everything seems urgent? Nursing prioritization may be one of the most challenging skills to master; with multiple patients, constant deadlines, and unexpected emergencies arising at the same time, how do you know what needs your attention first? This article will guide you through common prioritization frameworks such as ABCs, Maslow’s Hierarchy of Needs, and patient safety principles, so you can discern what needs to be addressed first — because getting it right can save a life.
What Is Nursing Prioritization?
Prioritization in nursing is the systematic process of deciding the order in which patient care needs and tasks should be addressed based on urgency, risk to patient safety, and clinical significance. It ensures that the most critical needs are recognized and managed first — especially when nurses are faced with multiple competing demands.
Effective prioritization allows nurses to focus on the most pressing needs, deliver safe and efficient care, and prevent minor issues from escalating into life-threatening problems.
Prioritization for Nurses: Useful Frameworks
Imagine walking into a busy hospital unit and seeing three patients at once. One is struggling to breathe; another screams, “I am itching all over after taking my medication!”; and a third threatens to leave against medical advice (AMA) if his bedding is not changed immediately. Which patient do you attend to first? To help make this decision, nurses rely on several time-tested principles:
1. ABC
The ABC framework stands for airway, breathing, and circulation. According to this approach, the airway takes the highest priority, because if it is blocked, oxygen cannot reach the lungs or the rest of the body, which can quickly become fatal. Breathing comes next; if a patient cannot breathe effectively, oxygen cannot enter the blood. Circulation is the third priority, referring to the movement of blood through the body and the delivery of oxygen and nutrients to vital organs such as the brain, heart, and others.
In emergency settings, triage nurses use the ABC framework to rapidly assess patients, prioritize those with life-threatening conditions, and ensure that they receive immediate care without delay.
| ABC Steps | Nursing Priority | Patient Signs and Symptoms |
|---|---|---|
| Airway | Ensure airway is clear | Choking sounds, airway obstruction, vomit in mouth, swelling of airway |
| Breathing | Ensure breathing is effective | Rapid shallow breathing, gasping, use of accessory muscles, cyanosis, wheezing from asthma attack |
| Circulation | Ensure blood flow | Severe bleeding, weak or absent pulse, pale/clammy skin, hypotension, signs of shock, cardiac arrest (no pulse, unresponsive) |
2. CAB
The CAB framework stands for circulation, airway, breathing and is primarily used in adult CPR for sudden cardiac arrest, rather than as a general primary assessment for all emergencies. In out-of-hospital cardiac arrest situations, the American Heart Association (AHA) 2010 guidelines recommend starting with chest compressions first (circulation) to restore blood flow quickly, which can improve survival. International resuscitation experts support this approach because research shows that early compressions are critical for effective CPR.
Some studies suggest that specific populations, such as hypotensive trauma patients with active hemorrhage, may also benefit from a CAB approach to resuscitation. However, ABC remains the standard practice for general first aid, lay-responder emergencies, and most clinical situations outside of sudden cardiac arrest.
Here’s a simple guide to help you distinguish between ABC and CAB. Always follow your workplace guidelines, as protocols may vary:
- ABC: Still the standard approach for general first aid, lay-responder emergencies, and most situations outside of sudden cardiac arrest.
- CAB: Primarily used for adult sudden cardiac arrest, especially in hands-only CPR performed by lay rescuers. In this case, start with chest compressions to restore circulation before addressing the airway and breathing.
3. Maslow’s Hierarchy of Needs
Maslow’s Hierarchy of Needs provides a framework for nurses to prioritize patient care by ranking needs from the most essential for survival to higher-level psychological and self-fulfillment needs. In practice, this means addressing physiological and safety needs first, before turning attention to emotional, social, and developmental needs.
Here’s a glimpse at this prioritization strategy to guide your practice:
| Priority Level | Focus Area | Examples of Nursing Interventions |
|---|---|---|
| 1. Physiological | Basic survival | Ensure airway, breathing, oxygenation; monitor vital signs; provide nutrition, hydration, manage pain; ensure rest/sleep |
| 2. Safety | Protection from harm | Ensure environment is free of hazards; prevent falls (bed rails up, non-slip socks); reduce infection risk (hand hygiene, clean surfaces); educate patient on call light use |
| 3. Love and belonging | Emotional support | Encourage family visits or video calls; provide reassurance during procedures; spend time listening to patient concerns |
| 4. Esteem | Self-respect and self-efficacy | Encourage patient to perform self-care tasks as able; provide choices when possible; respect privacy and personal space; offer positive feedback and encouragement |
| 5. Self-actualization | Achieving meaningful goals | Support patient goals (learning new skills, hobbies, or therapy goals); encourage participation in meaningful activities; involve patient in long-term care planning |
Principles of Prioritizing Care in Nursing
Prioritization requires nurses to use multiple strategies and clinical reasoning, not just one method. In addition to frameworks like the ABCs and Maslow’s Hierarchy of Needs, nurses must also integrate assessment of patient risk, time‑sensitive indicators, clinical data interpretation, and ongoing critical thinking to determine what requires attention first.
A key principle is recognizing the acuity of a patient’s condition, which refers to the complexity of care required and the likelihood of adverse outcomes if timely interventions are not provided. Patients with unstable vital signs, worsening or new symptoms, or issues related to ABCs — for example, ventilator patients or those with severe bleeding — are the ones most likely to require immediate prioritization.
In addition, time‑sensitive indicators must be factored into priority decisions. Tasks such as administering time‑critical medications (such as certain antibiotics or anticoagulants), preparing a patient for a scheduled procedure, or responding to calllights, must occur within specific timeframes to avoid harm or complications.
Finally, effective prioritization involves interpretation of patient data — trends in vital signs, lab results, and other clinical markers inform whether a patient’s condition is improving, stable, or deteriorating. Knowing your patients well and monitoring for changes in their condition over time are key to identifying who requires immediate attention and which can safely wait.
Prioritizing Nursing Interventions: Common Mistakes
Even when using a nursing prioritization framework, mistakes can occur. Being aware of these common prioritization errors can help you improve your decision-making and maintain patient safety:
- Prioritizing the loudest patient instead of the most critical: Patients who are vocal, anxious, or frustrated may demand attention, but nursing prioritization should always be guided by acuity and risk to patient safety — not volume of requests.
- Focusing on tasks rather than patient condition: Completing medications, documentation, or routine care should not take precedence over reassessing a patient with unstable vital signs or new symptoms. Priorities should be based on patient status, not task lists.
- Overlooking subtle changes in patient condition: Small shifts in vital signs, mental status, oxygen requirements, or pain patterns can signal early deterioration. Missing these trends may delay intervention and lead to complications.
- Failing to change priorities throughout the shift: Effective prioritizing in nursing requires continuous assessment. A patient who was not a priority earlier may rapidly become one due to new or worsening symptoms.
- Delaying escalation of care: Waiting to call the provider “just in case it’s nothing” — often due to fear of overreacting — can delay critical interventions. Timely escalation is essential to preventing patient deterioration and improving outcomes.
Make Your Career a Priority
Put your nursing prioritization skills to work in a role that aligns with your goals, values, and lifestyle. Get matched with quality nursing opportunities that align with your priorities — both inside and outside of work.