Nursing Prioritization and Delegation: How to Think Through Difficult Questions
The short answer
Prioritization asks who or what needs attention first and why. Delegation asks who else can safely do a task, and what you must still do. In both, you start with safety, look for acute change from baseline, and think about what needs a nurse's assessment and judgment.
A prioritization checklist
- Airway, breathing, circulation problems come before almost everything else.
- Acute or changing beats chronic or stable.
- Unstable beats stable; a change from the client's baseline is a signal.
- Actual problems beat potential ones, unless the potential problem is life-threatening and imminent.
- Safety and basic needs are used as tie-breakers in many courses; ask your instructor how your program frames them.
The five rights of delegation
Many nursing programs teach five rights: the right task, right circumstance, right person, right directions and communication, and right supervision and evaluation. In plain language: Is the task within the person's role and the employer's policy? Is the client stable enough? Does this person have the skill? Were the instructions clear? Will a nurse follow up?
What stays with the nurse
Regulators such as the College of Nurses of Ontario say that a nurse is responsible for their own actions but not for the decisions or actions of other care providers; when a nurse assigns a task, the nurse becomes accountable for assessing the situation, confirming that the person is competent, giving instruction when needed and following up. Tasks that need assessment or clinical judgment generally stay with the nurse. Exactly what can be assigned depends on legislation, your employer's policy, the person's role and competence, and the client's condition, so follow your province and workplace rules.
A worked example (fictional unit)
Situation: An RN has a PSW and an RPN on the team. At 08:00 the RN must decide who does what.
1. A stable resident needs a morning bath and a position change.
2. A resident who was admitted yesterday now has new confusion and a lower blood pressure than at midnight.
3. A routine dressing change is due on a stable wound.
Reasoning: The resident in item 2 has an acute change from baseline and needs a nurse's assessment first. The bath and position change in item 1 suit a PSW if the client is stable and the plan is clear, with instructions about what to report. Item 3 may suit an RPN depending on competence, policy and the wound; the RN confirms. The RN then checks back on each assignment.
Communicating a delegated task
"Please help Mr. A. with his bath and reposition him on his left side at 09:00. If you see any redness or he complains of pain, stop and tell me right away. Let me know when you are done."
Common mistakes
- Delegating a task that needs assessment.
- Giving unclear instructions, or none about what to report.
- Forgetting to follow up.
- Prioritizing by the client who is loudest rather than the client who is changing.
- Applying one province's scope rules in another.
Where Fiabita fits
Fiabita's Study Lab can turn your own notes into practice questions and flashcards. Generated items can be wrong or too easy, so check each one against your course materials and your instructor; it is a practice aid, not an answer key and not a substitute for your program.
FAQ
Q: Do these rules apply across Canada?
The reasoning is widely shared, but legislation, scopes of practice and titles vary by province and employer.
Q: Can a student delegate?
Student roles vary. Follow your school and agency rules and ask your instructor or preceptor before assigning or asking others to do anything.
Q: Is this legal advice?
No. It is educational. Use your regulator's standards for your role.
Sources and further reading
- CNO: Working with Unregulated Care Providers
- Nursing Management and Professional Concepts, Chapter 3: Delegation and Supervision (NCBI Bookshelf) — five rights of delegation; a U.S. open textbook, so confirm Canadian rules