Prioritization, Delegation. Assignment

Mastering the "Big Three": Prioritization, Delegation, and Assignment

Welcome, Future Nurse!

If you’ve ever looked at a HESI or NCLEX question and thought, "But all of these are right!"—you’re not alone. These exams don't just test your book knowledge; they test your clinical judgment.

The boards want to know: Can you keep your patients safe?

To answer that question, you have to master the three pillars of nursing management. We’ve broken them down into simple, easy-to-digest frameworks so you can stop second-guessing and start picking the right answer with confidence.

What We Cover in This Series:

Prioritization: Learning how to identify the "First Action" using the ABCs, Maslow’s, and the Acute vs. Chronic filter.
Delegation: Using the T.A.P.E. acronym to know exactly what you can (and absolutely cannot) hand off to your team.
Assignment: The "Charge Nurse" strategy for matching patient acuity to the right level of care.

Think of these guides as your roadmap from "Student Nurse" to "Safe Practitioner." Let's dive in!

The "Big Three"

Prioritization

Part 1: Prioritization: We know that "Select the best answer" is the phrase that haunts your dreams. When you’re looking at a HESI or NCLEX question and all four options are things a nurse actually does, how do you pick the one that earns you the points?Prioritization isn't just about what is important—it’s about what is urgent. Here is the "Cheat Sheet" for the first part of our series: The Hierarchy of Needs.🛑 The "Big Three" FrameworksIf you’re stuck between two "right" answers, run them through these filters in this specific order:1. ABCs (Airway, Breathing, Circulation)This is the gold standard. If a patient isn’t breathing or their heart isn't pumping, nothing else matters.Airway: Is it clear? (Think: choking, stridor, anaphylaxis).Breathing: Are they oxygenating? (Think: COPD exacerbation, RR of 30).Circulation: Is the blood moving? (Think: hemorrhage, shock, chest pain).2. Maslow’s HierarchyBefore you can address a patient's anxiety (Psychosocial), you have to address their literal survival (Physiological).Physiological First: Pain, thirst, hunger, elimination.Safety Second: Fall risks, infection control.Love/Belonging Third: Support systems, family.3. Acute vs. ChronicThe "New" or "Sudden" always trumps the "Expected."Priority: The patient with a 2-hour post-op sudden spike in heart rate.Not the Priority: The patient with chronic COPD who always has an $O_2$ saturation of 89%. (That is their "normal").💡 Pro-Tip for the HESIWhen you see the words "Initial," "First," "Primary," or "Most Important," the test is asking you: If you could only do one thing and then had to leave the room, which action would save the patient’s life?Remember: Don't read into the question! Don't add "What if..." scenarios. Stay focused on the data provided.Coming up next: We’ll dive into Delegation—knowing what you can safely hand off to a UAP or LPN so you can focus on these priorities!

What do I do FIRST?

The "First Action" Filter: What do I do right NOW? When a question asks what the nurse should do first, it is testing your ability to move from thinking to acting. Even if all four options are correct interventions, only one can be the starting point. 1. Assessment vs. Implementation (The "Look Before You Leap" Rule) In most cases, you must assess before you intervene. Scenario: A patient’s alarm goes off. Wrong: Call the doctor. Right: Check the patient’s level of consciousness or breathing. The Exception: If the question already gives you the assessment data (e.g., "The nurse notes the patient is unresponsive and pulseless"), skip assessment and go straight to the action (Start CPR). 2. The "Stay with the Patient" Rule If a patient is in acute distress (shortness of breath, chest pain, or a reaction to a blood transfusion), the "First" action is almost never "Leave the room to call the provider" or "Go to the pharmacy." Priority: Perform an immediate bedside intervention (e.g., stop the infusion, raise the head of the bed). 3. Least Invasive First If you have two ways to fix a problem, choose the one that is the least traumatic to the patient first—as long as it’s effective. Example: If a patient is struggling to breathe, raise the head of the bed (Positioning) before you go grabbing the intubation kit. 🧠 The "Safety First" Decision Tree When choosing the best answer, ask yourself these three questions in order: Is the patient's airway/breathing/circulation at risk? (If yes, fix that!) Do I have enough information? (If no, Assess!) Is there a quick, non-invasive fix? (If yes, do it!) Test-Taking Hack: If you see an answer choice that says "Assess," "Check," "Monitor," or "Determine," and you don't have enough data yet, that is usually your winner.

Delegation

Part 2: The Art of Delegation (The TAPE Rule)"I have so much to do, can't I just ask someone to help?"In nursing school and on the HESI, Delegation isn't just about being a team player—it's about Scope of Practice and Safety. If you delegate the wrong task to the wrong person, it’s your license on the line.To keep it simple, remember that the RN cannot delegate T.A.P.E. to an LPN or UAP/CNA.🚫 What the RN Must Keep: T.A.P.E.If a task falls into one of these four categories, the Registered Nurse must do it:T - Teaching: Initial education (e.g., teaching a new diabetic how to use an insulin pen). LPNs can reinforce teaching, but the RN starts it.A - Assessment: The initial or primary assessment. If a patient is "new" or "unstable," the RN must be the one to lay eyes and hands on them.P - Planning: Developing the nursing care plan and setting goals.E - Evaluation: Deciding if a treatment worked. Did the BP med work? Is the wound healing? The RN makes that call.✅ Who does what? (The Quick Guide)RoleCommon TasksUAP / CNAADLs (bathing, feeding), ambulating stable patients, vitals on stable patients, and "turning and positioning."LPN / LVNMed administration (usually no IV push), dressing changes, suctioning, and reinforcing education already started by the RN.RNEverything above + IV Push, blood transfusions, complex assessments, and clinical judgment.⚠️ The "Golden Rule" of DelegationNever delegate a task to someone if the patient is unstable. If a patient’s blood pressure is crashing, you don't ask a tech to "go grab a set of vitals." You go in yourself because that patient now requires an Assessment (part of TAPE!).Study Tip: On the exam, if an answer choice involves an LPN performing a "Serial Assessment" or "Monitoring" a stable patient, it might be right. But if it involves "Initial Assessment" or "Evaluating" a new symptom, it’s always the RN!

Assignment

Part 3: Mastering Patient Assignments (The RN's Strategic Move) You're the charge nurse, the shift is starting, and the board is full of patients. Who goes where? Assignment isn't just about dividing patients equally; it's about matching patient needs to the right nurse's skill set and legal scope of practice. For the HESI and NCLEX, remember this core principle: The sickest, most complex, or most unstable patients should always be assigned to the most qualified RN. 🔍 How the RN Decides: Matching Acuity with Skill When making assignments, a seasoned RN (or a smart nursing student on an exam!) considers several factors: Patient Acuity & Stability: Unstable patients (new post-ops, fresh admits, patients with unexpected changes, critical drips, new diagnoses) ALWAYS go to an RN. Stable patients with predictable outcomes can be assigned to an LPN if their needs fall within the LPN's scope and the RN is still responsible for overall supervision. Complex patients (multiple comorbidities, extensive teaching needs, those requiring frequent assessment/evaluation) ALWAYS go to an RN. Scope of Practice: RNs are responsible for initial assessments, complex teaching, clinical judgments, and evaluating patient responses. Therefore, patients requiring these skills must be assigned to an RN. LPNs can care for stable patients with predictable outcomes, perform specific tasks (meds, dressing changes), and reinforce teaching. They cannot perform initial assessments or make complex evaluations. UAPs/CNAs assist with ADLs, vital signs on stable patients, and basic care. Continuity of Care: Whenever possible, assign a patient to a nurse who cared for them previously. This promotes better care and patient satisfaction. (Though less frequently tested on exams as a first priority over acuity). 🛑 The "No-Go" Assignment Zones for LPNs/UAPs New Admissions: Require initial RN assessment and care plan initiation. Discharges with Teaching: Requires comprehensive RN teaching and evaluation. Patients requiring IV Push meds or Blood Transfusions: RN scope. Patients with unexpected changes or unstable conditions: Requires RN assessment, evaluation, and intervention. Patients undergoing complex procedures or requiring critical thinking: RN responsibility. HESI/NCLEX Tip: If you see a patient description that includes words like "new," "unstable," "sudden change," "first-time," or "complex teaching," that patient is the RN's assignment. If a patient is "stable," "chronic," or "predictable," an LPN might be appropriate, but only if an RN is supervising and the care is within their scope. This wraps up our series on Prioritization, Delegation, and Assignment! Mastering these three areas will boost your confidence and your scores.

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