Prioritization, Delegation, and Assignment: How to Implement and Best Practices

For nurses, especially those who will find themselves in a position of leadership at some point and time, it is imperative to have an understanding of the importance of prioritization, delegation, and assignment. While people who are really good at a specific thing will develop a proclivity of wanting to take charge and do everything on their own, such an approach would prove highly ineffective in delivering quality medical care for multiple patients. For this reason, the charge nurse, or the nurse supervisor, will have to develop an administrative ability that will allow them to effectively prioritize, delegate and assign tasks in a manner in which the highest level of quality and proficiency is reached.

For any nurse, there is a natural process of order when making decisions concerning the direct care of a patient. There is such a thing as the nursing process, which is a basic guideline that nurses use to help manage their decision-making process. Generally speaking, this process consists of five steps that include assessment, nursing diagnosis, planning, intervention and evaluation — usually completed is a specified or systematic order.

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What Is Prioritization, Delegation, and Assignment?

Much in the same manner in which every nurse must develop the capacity to follow the nursing process guidelines to reach a reasonable and acceptable decision in the treatment of a patient, it is equally important for a nurse who is operating in a position of authority, in which other nurses are functioning under their authority and leadership, to develop the capacity to assess the need of the patients, the department and the staff at any given time. The purpose of this is for developing a specified plan of action that will ensure that the needs of the patients are met, and the members of the staff are receiving the necessary support.

Implementing the Prioritization, Delegation, and Assignment Protocol

The first step in the prioritization, delegation, and assignment process is to prioritize the actions, tasks and responsibilities, as well as the needs of the patients involved. Prioritizing actionable ensures that those things that have the greatest gravity, as far as importance is concerned, will receive immediate attention in correspondence to where they fall on the priority list. Once the head nurse has successfully prioritized all needs and functions, the step in the prioritization, delegation, and assignment process is to delegate these responsibilities to those who have the capacity to carry them out at specified level.

The capacity to delegate demands the lead nurse have a lucid understanding of the skills, experience and physical capacity of all people involved. It does not make much sense to delegate an assignment to an individual who does not have the skill set or physical capability to carry out the assignment. If the staffing has been executed properly, there should be individuals on each shift who create a collective synergy in which all necessary requirements of performance and service can be met by at least one person on the shift. This ensures that the lead nurse will be able to delegate responsibilities with confidence that the assignments will be carried out.

In the right situation, the lead nurse will not be a micromanager, which has proven to highly counterproductive when it comes to dealing with highly skilled positions. Again, when the staffing has been done correctly, there will not be a need for the lead nurse to micromanage their staff.

How These Best Practices Are Carried Out

The implementation of the prioritization, delegation, and assignment protocol is facilitated through direct and comprehensive communication between the lead nurse and all those who are under their supervision. While physicians may interact directly with nurses and other staff members in certain situations, it is a common practice for direct instructions to be communicated to the lead nurse. This direct communication between the physician and the nurse supervisor is to ensure that there will be no gaps in communication — reducing the chance for things to fall through the cracks.

Because of the presence of multitudinous variables, it will be necessary for the nurse supervisor to have the ability to be flexible in the manner that will allow for the unexpected.

The supervising nurse has a number of considerations when delegating and assigning care.

  • When care is being delegated or assigned to an unlicensed assistive personnel (UAP), the lead nurse cannot delegate any type of activity that would require nursing judgement at any point. Things that are included in nursing judgement include teaching, assessing, educating, caring for an unstable patient, administering medication and more.
  • When assigning care to an LPN, the RN has the option of assignment the administration of some medications, but assignments that require the judgement of a registered nurse, such as assessing, educating and teaching would still be reserved for an RN on staff.
  • As a general rule, the most experienced nurse will be assigned to the patient who is most in need of critical care.
  • A graduate nurse would be able to provide care for any patient that is receiving care from a student with supervision.

Finally, this process is not linear, nor is it a one-size-fits-all application. The lead nurse will have to be able to bring all of the right pieces together. In some work environments, the lead nurse will play a substantial role in building their team, while others are forced to play with the hands that they are dealt. As privatization becomes more of a reality, competition becomes more central, meaning that nurses will likely be given what they need to not only be successful, but to produce the highest quality results.

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Lead nurses will be required to acquire all necessary information, analyze the data, subsequently making inferences based on the information they have at their disposal. In many cases this process can be very easy, especially when all of the required information is available; however, there will be times in which things can become more complicated, when there are gaps in the data. It is times like this when critical thought and nursing judgment play a vital role in the decision making process.

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