Prioritizing and Organizing Care

Organizing and Managing Organizing and Managing ResourcesResources

Prioritizing and Organizing Care for a Group of Patients

Priority-Setting PrinciplesPriority-Setting PrinciplesThe nurse must be able to judge

priority needs in common situations for:

◦individual patients

◦a group of patients

Individual Patient NeedsIndividual Patient NeedsTo determine and rank priority of

individual patient needs, the nurse must:◦assess the patient’s condition and

responses to health problems and treatment

◦determine perceived urgency of the patient’s needs in terms of predictable risks or consequences

Categories of priority Categories of priority needsneeds1. First-order priority needs

2. Second-order priority needs

3. Third-order priority needs

4. Fourth-order priority needs

First-Order Priority NeedsFirst-Order Priority NeedsThreats to immediate survival or

safety

Those that demand immediate nursing intervention(s)

Second-Order Priority Second-Order Priority NeedsNeedsActual problems for which the

patient or family has requested help

Those that require prompt nursing intervention(s) to prevent problems from becoming worse

Third-Order Priority NeedsThird-Order Priority NeedsActual or potential problems of

relative urgency that the patient or family does not recognize

Those that require the nursing staff to monitor and manage them

Fourth-Order Priority Fourth-Order Priority NeedsNeedsActual or potential problems that

the patient or family may need help to resolve in the future

Those that require the nursing staff to assess the ability of the patient or family to perform care or provide assistance after discharge

Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must know the needs

and priorities of needs of each patient by:

◦considering data from change-of-shift report and/or acuity classifications

◦completing all patient assessments ASAP while attending to first- and second-order priority needs

Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must consider factors

that affect prioritization of care, such as:

◦the amount of time and types of skills required to complete nursing activities

◦the types and numbers of available, qualified staff

Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must be flexible in

responding to priority needs by:

◦allocating resources to meet unpredicted first- and second-priority needs

◦considering each patient’s primary goals

◦collaborating with other disciplines to address priority needs

Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must be creative in

responding to priority needs by:

◦emphasizing patient abilities and strengths

◦facilitating patient adjustment to limitations and disabilities

◦considering the influence of diverse cultural and ethnic backgrounds

Principles of Work Principles of Work OrganizationOrganizationDetermine short- and long-term

patient outcomes

◦Short-term outcomes establish work priorities for a specified period of time, i.e. during a work shift

◦Long-term outcomes guide work organization over longer periods of time, i.e. during a hospital stay

Principles of Work Principles of Work OrganizationOrganizationMake a “things-to-do” list

◦At the beginning of each shift, determine the essential activities that must be accomplished during the shift

◦Then make a written list including those essential activities

Principles of Work Principles of Work OrganizationOrganizationRank activities on the “things-to-

do” list

◦Identify those that have a specific time limit to accomplish or those that have specific scheduled times

◦Note the amount of time needed to complete each activity

◦Determine which activities require the help of others to complete

Principles of Work Principles of Work OrganizationOrganizationEliminate unnecessary steps and work

◦ Assemble needed equipment and supplies prior to entering patient care areas

◦ Group similar tasks done at the bedside◦ Complete one task or group of tasks before

beginning another task or group of tasks◦ Collaborate with co-workers to avoid

duplication of gaps in care◦ Involve support staff in non-clinical duties

to the greatest extent possible◦ Evaluate time management efforts

continuously

Principles of Work Principles of Work OrganizationOrganizationPlan for unexpected demands

◦Unpredicted situations and needs must be expected and included in time management plans

◦Ideally time should be allotted to a skilled team member to manage unexpected demands

Principles of Work Principles of Work OrganizationOrganizationSet limits on unreasonable

demands

◦Unreasonable assignments are those that cannot be accomplished with the available time and resources regardless of educational preparation, practice skills, and good intentions

◦Notify the supervisor if the assignment is unreasonable

◦See BON rule 217.11 (1)(T) and BON rule 217.12 (I)(E)

Principles of Time Principles of Time ManagementManagementUnderstand personal time perception

and time inclinations

◦ Personal time perception and time inclinations can affect how an individual uses time and responds to time

◦ Individual time perception is influenced by personality, culture, and environment

◦ Personal time inclinations are determined by time style, time orientation, and dominant brain side

Principles of Time Principles of Time ManagementManagementStreamline work

◦ Streamlining work refers to doing the work that cannot be eliminated or delegated more efficiently

◦ Some suggestions are: Gather materials for a task all at one time Multitask at the patient’s bedside Schedule a special time for priority tasks Ask questions about treatments or medications

before proceeding, if necessary Trust your intuition about changing patient status

Principles of Time Principles of Time ManagementManagementKeep a time log

◦Time perception is “elastic”◦A time log is an objective source of

information about how time is actually spent

◦Time logs can help an individual eliminate or reduce the amount of time spent on nonproductive or minimally productive activities

Principles of Time Principles of Time ManagementManagementReduce interruptions

◦ Interruptions are a part of the nursing work environment

◦ Some tips to handle interruptions are: Close the door to a patient’s room when engaged

in patient care activities Ask visitors, colleagues, physicians and other

professionals to wait until you can complete what you are doing in a firm but courteous manner

Involve non-licensed personnel, if appropriate, in patient care activities and assisting others

Principles of Time Principles of Time ManagementManagementCategorize activities

◦Cluster related activities or tasks as much as possible, i.e. document assessment findings during the assessment

◦Try to see one task through to completion before starting another task

Principles of Time Principles of Time ManagementManagementBe aware of factors that inhibit

effective time management and some possible solutions reduce or eliminate these factors

◦ There are a variety of personal and environmental factors that inhibit the effective use of time, such as: Procrastination Complaining Disorganization Trying to do too much