Fundamentals · 12 min read
Prioritization Frameworks
ABCs, Maslow, the nursing process and acute-over-chronic — applied in the order that resolves conflicts.
Run the frameworks in order
Start with the ABCs. A partially obstructed airway beats a hemorrhage; a hemorrhage beats a pain complaint. Only when no option threatens airway, breathing or circulation do you move to the next filter.
Then apply the nursing process: assessment precedes planning, implementation and evaluation. If two options both look reasonable and one is an assessment, the assessment usually wins — unless the client is actively dying, in which case you act.
Then apply Maslow: physiological needs before safety, safety before love and belonging, and so on. Psychosocial answers are rarely the priority when a physiological option is present, with the exception of active suicidal ideation.
Test pattern
'Which client should the nurse see first?' is asking who is most likely to deteriorate in the next few minutes — not who is sickest overall and not who is most upset.
Expected versus unexpected
A finding that fits the diagnosis is expected and can wait. A finding that does not fit is unexpected and demands attention. Serous drainage on a post-operative day one dressing is expected; a sudden gush of bright red blood is not.
Apply the same lens to vital signs. A temperature of 38.1°C on post-operative day one is often atelectasis-related and expected; the same temperature on day four suggests infection.
- New confusion in any client is never expected — investigate
- Rising respiratory rate is the earliest reliable sign of deterioration
- Restlessness in a hypoxic client precedes cyanosis by a long margin
Next lesson
Delegation & Scope of Practice