Reference
Who you see first, and what you can hand off.
Prioritization and delegation items are judgment questions. Apply a framework deliberately rather than choosing what feels urgent.
Airway, Breathing, Circulation
An airway or breathing problem outranks everything else, every time.
Stridor after extubation is seen before a blood pressure of 88/56.
Acute before chronic
A new change from baseline outranks a long-standing stable finding.
New confusion in an older adult outranks chronic knee pain.
Unstable before stable
Trends matter more than single numbers — falling output, rising CO₂, dropping pressure.
Urine output of 15 mL/hr for three hours is assessed before a scheduled dressing.
Maslow after physiologic safety
Physiologic needs first, then safety, then psychosocial and teaching needs.
Treat hypoglycemia before addressing anxiety about discharge.
Least invasive first
When interventions compete, choose repositioning, oxygen and assessment before invasive steps.
Raise the head of the bed and apply oxygen before preparing for intubation.
Unlicensed assistive personnel (UAP)
Safe to assign
- Bathing, feeding, ambulating and repositioning stable clients
- Routine vital signs, intake and output, and weights
- Collecting non-sterile specimens and stocking supplies
Never delegate
- Any assessment, teaching, evaluation or care planning
- Care of an unstable client or first-time ambulation after surgery
- Medication administration or interpretation of findings
Licensed practical/vocational nurse (LPN/LVN)
Safe to assign
- Stable clients with predictable outcomes
- Routine medications by most oral and many parenteral routes per state rules
- Sterile dressing changes, tracheostomy care, tube feedings, reinforcing teaching
Never delegate
- Initial assessment or the initial care plan
- IV push medications, blood products or titrated drips (most states)
- Client education that introduces new content, and clients who are unstable
Registered nurse (keep it)
Safe to assign
- Assessment, analysis, planning, evaluation and teaching
- Unstable clients, new admissions and anything requiring nursing judgment
- Blood administration, IV push, titration and central line care
Never delegate
- Nothing on this list may be delegated away from the RN.
Practice this
Prioritization items live in the Management of Care category.
Open practice modes →Draft demonstration item — requires clinical review.