🚨 Lecture 12
Prioritization & Delegation
4 rules, modifying phrases, LPN vs RN vs UAP delegation. 🔥 MOST TESTED!
4 Priority Rules
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MOST TESTED lecture! At least 15 NCLEX questions from this section!
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The MODIFYING PHRASE is ALWAYS more important than diagnosis, age, or gender!
1️⃣
ACUTE beats CHRONIC — Appendicitis > COPD/CHF
2️⃣
FRESH POST-OP (<12 hrs) beats everything — Even other surgical patients!
3️⃣
UNSTABLE beats STABLE — Changing/unexpected assessment = unstable = higher priority
4️⃣
TIE BREAKER: Most vital organ wins
Brain > Lung > Heart > Liver > Kidney > Pancreas (use organ from MODIFYING PHRASE)
Brain > Lung > Heart > Liver > Kidney > Pancreas (use organ from MODIFYING PHRASE)
| STABLE | UNSTABLE |
|---|---|
| Chronic illness, unchanged | Acute illness, changing assessment |
| Post-op >12 hrs, admitted >24 hrs | Post-op <12 hrs, newly admitted |
| Expected symptoms of diagnosis | UNEXPECTED symptoms |
| Lab abnormalities A or B level | Lab abnormalities C or D level |
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Always unstable even if expected: Hemorrhage | Fever >105°F | Hypoglycemia | Pulseless/Breathless
Delegation
LPN CANNOT Do:
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Start IV | Hang/mix IV meds | Push IV meds (can only MAINTAIN IV + document flow)
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Administer blood | Handle central lines
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MAKE care plan (can implement it) | Develop teaching (can reinforce it)
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Care for UNSTABLE patients
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The FIRST of ANYTHING (first dressing, first feeding, first ambulation, first assessment after change)
UAP CANNOT Do:
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Chart about the PATIENT (can chart what they did)
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Medications (except topical OTC + barrier creams)
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Assessments (exception: vitals, Accu-Chek) | Treatments (exception: enemas)
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The FIRST of any ADL
⚠️
NEVER delegate safety to family/friends unless trained and DOCUMENTED
Staff Management
| Situation | Action |
|---|---|
| Staff doing something ILLEGAL | Tell SUPERVISOR |
| Not illegal but someone in IMMEDIATE HARM | CONFRONT + take over NOW |
| Simply INAPPROPRIATE (no harm) | Talk to them LATER privately |
| Ignore it | NEVER the right answer! |
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NEVER ignore inappropriate staff behavior — always use it as a teaching opportunity!
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Mass casualty BLACK TAG: Pulseless | Breathless | Fixed + dilated pupils → "Tag black, ship last"
📖 Notes for Dummies
🧠 Think of it this way…
Prioritization is the most tested topic on NCLEX because it's the heart of nursing — deciding who needs help NOW vs who can wait. The secret is to ignore age and gender and focus entirely on the MODIFYING PHRASE (what's happening to the patient right now).
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The modifying phrase is the key:
Example: "65-year-old with COPD who spiked a fever this afternoon" — the fever spiked TODAY is more important than the COPD diagnosis! "This afternoon" = unexpected = unstable = highest priority.
Example: "65-year-old with COPD who spiked a fever this afternoon" — the fever spiked TODAY is more important than the COPD diagnosis! "This afternoon" = unexpected = unstable = highest priority.
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4 rules in plain English:
1. New/sudden problem (acute) beats old problem (chronic)
2. Fresh out of surgery (<12 hours) = highest priority, period
3. Something CHANGED → that person is now your priority
4. If still tied → brain problems win over lung problems win over heart problems, etc.
1. New/sudden problem (acute) beats old problem (chronic)
2. Fresh out of surgery (<12 hours) = highest priority, period
3. Something CHANGED → that person is now your priority
4. If still tied → brain problems win over lung problems win over heart problems, etc.
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LPN scope of practice — the simple version:
The LPN can do ROUTINE, STABLE, EXPECTED care. The RN must do anything that involves new assessment, change in condition, first-time procedures, teaching, care planning, IV medications, or unstable patients.
The LPN can do ROUTINE, STABLE, EXPECTED care. The RN must do anything that involves new assessment, change in condition, first-time procedures, teaching, care planning, IV medications, or unstable patients.
📝 Delegation made easy:
LPN: "I can do this every day without any new assessment" = safe to delegate
RN: "This involves assessing something new or managing an unstable patient" = RN only
UAP: "This is a simple personal care task (bathing, turning, feeding after first time)" = UAP can help
Golden rule: Never delegate what you haven't assessed first!
LPN: "I can do this every day without any new assessment" = safe to delegate
RN: "This involves assessing something new or managing an unstable patient" = RN only
UAP: "This is a simple personal care task (bathing, turning, feeding after first time)" = UAP can help
Golden rule: Never delegate what you haven't assessed first!