Lock It In
Priority Is a Physiologic Decision
Priority setting is not a queue based on who arrived first, who is calling most often, or which task is easiest to complete.
Priority setting is not a queue based on who arrived first, who is calling most often, or which task is easiest to complete. It is a decision about which patient has the greatest immediate threat and which delay is most likely to cause harm. Begin with a rapid check for failure of airway, breathing, or circulation. The first life-threatening problem identified in any of these areas takes precedence over routine medications, documentation, comfort measures, or discharge planning. A patient with new respiratory distress outranks a stable patient requesting analgesia. A patient with signs of postoperative hemorrhage outranks a patient waiting for routine vital signs. This framework does not make pain or anxiety unimportant. It asks whether the symptom is an isolated comfort concern or a signal of deterioration. Anxiety may accompany hypoxemia, shock, or delirium; treating it as “just anxiety” can delay recognition of the actual threat. Experienced nurses look for a change from baseline and for patterns rather than isolated numbers. A chronic low oxygen saturation may be expected when it is unchanged and the patient is comfortable, alert,...