Prioritization and Delegation and Staff Management Notes:
Patient group scenario questions: The basis is which patient is the sickest or
which patient is the healthiest.
Example: There’s been a disaster in your town and you have to discharge one of the
following people to make room for incoming wounded; who would you discharge?:
(In these situations, you would be looking for the lowest priority client.)
The other most common patient group scenario question type you will get sounds along
the lines of: “You are receiving an oncoming shift report from the departing nurse, after you
have received this report; which patient would you deem your highest priority (to see
first)?
(In these situations, you would be looking for the highest priority client.)
Key point: Don’t get turned around in the middle of the question
Another key point: The answers usually have 4 parts; the age, gender, a diagnosis, and a
modifying phrase.
Example: A ten year old male, with hypospadias, who is throwing up bile stained
emesis. Two of these pieces of information are irrelevant and are not to be used in your answer;
which 2 are irrelevant? (Age and gender).
Pediatrics questions however, one must pay attention to the age; in over all general
prioritization questions involving all ages this rule does not matter. Gender in over all
general prioritization questions also does not apply, as a determining factor.
Diagnosis can be an importan t factor but the most important determining factor is the
modifying phrase. This is always the most important component of those questions.
Example: If this patient had angina pectoris vs another patient having myocardial
infarction, which one would be of higher priority? The myocardial infarction patient of
course. Now adding the modifying phrases to the end of each one of course; Now we have a
patient with angina pectoris that has unstable BP vs a patient with myocardial infarction
that has stable vital signs. Which one would be of higher priority? The Angina Pectoris patient
, with unstable BP. That being the key word (unstable). Break the tie in favor of the modifying
phrase if you feel you are stuck.
The 4 rules for prioritization:
1) Acute beats chronic, an acutely ill individual is higher priority than a chronically ill
individual.
Example: If you have the following patients: a COPD, a CHF, and an appendicitis patient; who
would be of the highest priority? The appendicitis case. This is because the other two are
chronic illnesses as to where the appendicitis is acute. In these types of scenarios do not use the
ABC’s method for picking the answer. This is an acute vs chronic based scenario.
2) Fresh post op (12 hours) beats medical or other surgical cases
Example: If you have the following patients: a COPD, a CFH, an appendicitis case, a 2 hour post
cholecystectomy, and a secondary to post op coronary bypass graft. Which one is of utmost
priority? The 2 hour post op cholecystectomy. This is because they are fresh post op and beat
out medical and other surgical cases. Throw in a radical neck dissection and still the 2 hour post
op is the highest priority case since it is fresh. Amputation and craniotomy still rank lower
than that case because they simply are not fresh as that case; freshly done that is.
3) Unstable beats Stable
Use of the word stable, makes the patient stable; nothing more and nothing less. If it says
they are stable, then they are. Use of the word unstable makes the patient unstable, nothing
more and nothing less. If it says they are unstable, then they are.
Another thing that makes the patient stable, chronic illness. Acute illness makes a patient
unstable.
Post op greater than 12 hours, also makes the patient stable. Post op less than 12 hours makes
the patient unstable.
Local or regional anesthesia makes the patient stable, General anesthesia makes the patient
unstable, although only in the first 12 hours.
Lab abnormalities of an A or B level are stable, Lab abnormalities of C or D level makes the
patient unstable.
Patient group scenario questions: The basis is which patient is the sickest or
which patient is the healthiest.
Example: There’s been a disaster in your town and you have to discharge one of the
following people to make room for incoming wounded; who would you discharge?:
(In these situations, you would be looking for the lowest priority client.)
The other most common patient group scenario question type you will get sounds along
the lines of: “You are receiving an oncoming shift report from the departing nurse, after you
have received this report; which patient would you deem your highest priority (to see
first)?
(In these situations, you would be looking for the highest priority client.)
Key point: Don’t get turned around in the middle of the question
Another key point: The answers usually have 4 parts; the age, gender, a diagnosis, and a
modifying phrase.
Example: A ten year old male, with hypospadias, who is throwing up bile stained
emesis. Two of these pieces of information are irrelevant and are not to be used in your answer;
which 2 are irrelevant? (Age and gender).
Pediatrics questions however, one must pay attention to the age; in over all general
prioritization questions involving all ages this rule does not matter. Gender in over all
general prioritization questions also does not apply, as a determining factor.
Diagnosis can be an importan t factor but the most important determining factor is the
modifying phrase. This is always the most important component of those questions.
Example: If this patient had angina pectoris vs another patient having myocardial
infarction, which one would be of higher priority? The myocardial infarction patient of
course. Now adding the modifying phrases to the end of each one of course; Now we have a
patient with angina pectoris that has unstable BP vs a patient with myocardial infarction
that has stable vital signs. Which one would be of higher priority? The Angina Pectoris patient
, with unstable BP. That being the key word (unstable). Break the tie in favor of the modifying
phrase if you feel you are stuck.
The 4 rules for prioritization:
1) Acute beats chronic, an acutely ill individual is higher priority than a chronically ill
individual.
Example: If you have the following patients: a COPD, a CHF, and an appendicitis patient; who
would be of the highest priority? The appendicitis case. This is because the other two are
chronic illnesses as to where the appendicitis is acute. In these types of scenarios do not use the
ABC’s method for picking the answer. This is an acute vs chronic based scenario.
2) Fresh post op (12 hours) beats medical or other surgical cases
Example: If you have the following patients: a COPD, a CFH, an appendicitis case, a 2 hour post
cholecystectomy, and a secondary to post op coronary bypass graft. Which one is of utmost
priority? The 2 hour post op cholecystectomy. This is because they are fresh post op and beat
out medical and other surgical cases. Throw in a radical neck dissection and still the 2 hour post
op is the highest priority case since it is fresh. Amputation and craniotomy still rank lower
than that case because they simply are not fresh as that case; freshly done that is.
3) Unstable beats Stable
Use of the word stable, makes the patient stable; nothing more and nothing less. If it says
they are stable, then they are. Use of the word unstable makes the patient unstable, nothing
more and nothing less. If it says they are unstable, then they are.
Another thing that makes the patient stable, chronic illness. Acute illness makes a patient
unstable.
Post op greater than 12 hours, also makes the patient stable. Post op less than 12 hours makes
the patient unstable.
Local or regional anesthesia makes the patient stable, General anesthesia makes the patient
unstable, although only in the first 12 hours.
Lab abnormalities of an A or B level are stable, Lab abnormalities of C or D level makes the
patient unstable.
