In the world of nursing, the loudest voice isn’t always the most urgent. Knowing which patient to attend to first is the difference between a controlled shift and a disorganized one.
How can you know which case is most urgent?
In this article, learn all about nurse prioritization, from the ABCs of nursing to the signs of patient deterioration, and how to triage patients.
Whether you are a nursing student preparing for your clinicals or the NCLEX, or if you are a recently graduated nurse, you will learn how to confidently know who to treat first.
What are the ABCs of nursing prioritization?
The ABCs of nursing prioritization are:
- Airway
- Breathing
- Circulation
These 3 aspects form a critical, hierarchical framework for rapidly assessing and treating life-threatening conditions.
To master triage, a nurse needs to know how to view a patient through this “lens of survival”.
Airway: The absolute priority
As a nurse, you need to know that the airway is always the top priority.
The scary part? An airway obstruction could lead to brain death in minutes.
It can be caused by:
- Physical blockage
- Choking
- Anaphylaxis
Maintaining a patient's airway is the first step in your assessment. Always.
Subtle signs of a failing airway or breathing
Failing airway or breathing doesn’t always look like gasping.
Early hypoxia can look like:
- Restlessness
- Confusion
- Agitation
If a patient is calm and then suddenly becomes agitated or anxious, check oxygen levels immediately. Some patients even report a feeling of “impending doom” beforehand.
Breathing
After confirming the airway is open, assess the patient’s lungs.
Look for signs of respiratory distress:
- Cyanosis (bluish tint of the skin)
- Increased heart rate
- Confusion
- Lower oxygen saturation
- Labored breathing
Circulation: Perfusion
Checking circulation helps you to identify shock or hemorrhage.
For this, you need to monitor:
- Blood pressure
- Capillary refill
- Heart rate
Ensure vital organs receive adequate perfusion.
The hidden circulation issues
The patient may appear stable, but they can have issues with blood pressure or tachycardia (rapid heart rate). Those are early indicators of internal bleeding and sepsis.
Look for these signs of shock and act early.
NCLEX tip: If you are a nursing student, you already know that NCLEX prioritization questions are hard to master. Your test might ask you to choose first between the screaming patient and the silent one. If you want to survive on the floor, take the emotion out of it and rely on your ABCs.
Beyond the ABCs
While the ABCs save lives, many nurses also learn to use the D (disability) and the E (exposure) during emergencies:
- Disability: Checking for neurological deficits (such as a stroke).
- Exposure: Assessing for hidden wounds, rashes, or environmental factors like hypothermia.
The screaming patient vs. the silent patient
Yes, you might be terrified of the screaming in an emergency room. However, silence is usually more dangerous.
- The myth of the loudest patient: If you analyze the ABCs, the screaming patient passes A and B. While their pain is real and requires intervention, they are stable.
- The danger of a silent patient: A quiet, lethargic, and unresponsive patient is a big red flag. Silence might mean the body is redirecting all resources to stay alive.
So, who do you assess first?
Your nursing emergency response must be to the unresponsive patient first. After life-threatening conditions are stabilized, always prevent injuries next.
Pro tips for rapid nursing prioritization
When it comes to prioritizing and triage in nursing, you need to be fast.
Here are 3 tips to help:
- Trust your gut: If you think a patient needs attention, check on them.
- Remember Maslow’s hierarchy of needs: Meet the patient’s physiological needs (oxygen, fluids, temperature) before safety or comfort.
- Delegation: Know when to delegate stable patients so you can focus on an urgent case.
5 FAQs of nursing prioritization
Some common questions about nursing prioritization include:
1. What if both patients have airway issues?
If you have 2 patients with airway issues at the same time, prioritize the one acutely deteriorating over the “more stable” one.
2. Does pain ever come before the ABCs?
Generally, no. The only exception is chest pain, which can indicate a circulation issue or a cardiac event. If you rule out a cardiac event, continue with your ABCs.
3. How can I prioritize if all my patients are stable?
If your ABCs are “fine” for all your patients, then use a framework based on Maslow’s hierarchy for stable patients:
- Safety: Is the patient safe? For instance, are the bed rails up and the call light near?
- Acute change: Is there a sudden change in the patient’s condition?
- Routine care: Are there scheduled medications, dressing changes, etc?
4. What is the difference between ABC and CAB?
“ABC is for the living, CAB is for the dead (or dying).”
ABCs are for conscious or breathing patients. If a patient is not breathing or unresponsive and in cardiac arrest, you switch to CAB (Compressions/Circulation, Airway, Breathing).
Getting blood moving to the brain via compressions is the priority.
The American Heart Association recommends that, if a patient is without a pulse, compressions should be performed before A and B.
5. Can I delegate prioritization to a licensed practical nurse?
No, you can’t delegate prioritization to a licensed practical/vocational nurse (LPN/LVN) or a certified nursing assistant (CNA).
You can delegate some tasks, such as taking vitals or assisting with patient care. Still, you must perform the prioritization yourself or have another registered nurse (RN) perform it, if available.
As an RN, you are responsible for:
- Assessment
- Clinical judgment
- Prioritization
Your team can help you execute the how after you’ve done these processes.
Ready to put your skills to the test?
Whether you are a nursing student or a working nurse, knowing your ABCs will help you save lives.
Even if a screaming patient demands attention, as nurses, we need to follow our instincts and protocol.
Take your skills to the patients who need you. With Nursa, you will find high-paying per diem shifts, even as a recently graduated nurse in your area.
Put your critical thinking to work. Create an account and look for shifts with Nursa. Get started today.
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