How to Prioritise Patient Care as a New Graduate Nurse

One of the most challenging parts of starting as a new graduate nurse is working out what to do first. When you have multiple patients, competing tasks, and constant interruptions, it can feel very overwhelming, especially if the first clinical area you work in has differing levels of patient acuity and a fast pace. Prioritisation is about deciding what matters most and acting on it. There are various ways to prioritise care, such as assessing airway, breathing and circulation (ABC), Maslow’s Hierarchy of Needs and the CURE Hierarchy.

What you need to know

Prioritisation is the process of deciding the order in which care is delivered based on risk, urgency, and patient need. Not all tasks carry the same level of importance, even if they are all expected to be completed during the shift.

In general, priority should be given to:

• patients who are unstable or showing signs of deterioration

• time-critical tasks such as medications, procedures, or reviews

• new or worsening symptoms that require assessment

Lower priority tasks are those that can be delayed safely without impacting patient outcomes. Learning to recognise this difference is what allows you to manage your workload more effectively. A point to remember is to utilise support available, even if that means confirming with an experienced nurse whether your prioritisation of tasks is correct.

There are several structured approaches that can be used to guide the prioritisation of patient care, particularly when managing multiple competing clinical needs.

Airway, Breathing, Circulation (ABC)
This approach, which often also incorporates the letters D (disability) and E (exposure), prioritises immediate life-threatening conditions by assessing and managing the airway first, followed by breathing and circulation. It is commonly used in acute and emergency settings to ensure that oxygenation and perfusion are maintained before addressing other clinical concerns. Disability refers to neurological status (for example, reduced consiousness, confusion, unequal pupils, seizure activity and blood glucose levels (BGL)) and exposure refers to a full body assessment (for example assessing the skin for wounds, rashes, bruising, or signs of bleeding or injury, as well as assessing patient temperature and for medical devices).

Example: A nurse attends to a patient who suddenly becomes unresponsive. They immediately assess airway patency, note obstructed breathing, and reposition the patient while applying oxygen before moving on to circulation and calling for assistance.

Maslow’s Hierarchy of Needs
This framework prioritises care based on fundamental human needs, with physiological requirements such as oxygenation, hydration, and safety addressed before higher-level needs. It is useful for guiding holistic care beyond immediate clinical instability.

Example: A nurse caring for multiple patients prioritises administering oxygen and fluids to a patient with respiratory distress before addressing another patient’s request for discharge paperwork, as physiological needs take priority.

CURE Hierarchy
The CURE hierarchy (Critical, Urgent, Routine, Extras) organises care based on clinical urgency and time sensitivity, helping clinicians prioritise tasks by identifying what must be done immediately versus what can safely wait. Critical tasks are for immediate life threatening needs, Urgent for tasks requiring prompt attention, Routine for standard care, and Extras for non essential tasks that can be delayed.

Example: At the start of a shift, a nurse identifies a patient with deteriorating observations as critical, a patient requiring time-sensitive medication as urgent, routine observations as routine, and a patient wanting to go outside for fresh air as extras, organising care accordingly.

Clinical urgency
This approach prioritises care based on which patient is most unstable or at greatest risk of deterioration. It focuses on identifying abnormal observations, concerning trends, and clinical signs that indicate a patient may deteriorate, ensuring those at highest risk are assessed and managed first.

Example: A nurse notices one patient’s respiratory rate rising and blood pressure trending down, while another patient is stable but awaiting wound care. They prioritise assessing and escalating the deteriorating patient first based on risk of decline.

Beyond the basics

As early career nurses and students, it’s common to prioritise based on what is next on the list or what feels easiest to complete. However, for safe clinical practice this needs to shift towards prioritising based on clinical risk. This means looking at your patients as a whole rather than focusing on individual tasks. For example, if you are completing a medication round and one your your patients reports new chest pain, your priorities need to shift immediately. If your other patients are stable, then the patient with chest pain becomes the highest priority due to the potential for rapid deterioration.

The focus then moves to immediate assessment and escalation. This may include:

• completing a focused cardiac assessment

• obtaining vital signs

• performing an ECG and venipuncture for cardiac enzymes, if appropriate

• notifying the nurse in charge and medical team

Once the patient has been assessed and appropriate action has been taken, you can then return to the medication round. If priority medications cannot be given or you are unable to appropriately care for all patients, you may need to escalate to senior nursing staff for support. Remember, there will be times when you will be required to be proactive in asking for support, as your colleagues may not always be aware that you require assistance.

How to put it into practice

Start your shift by identifying which patients are most likely to deteriorate or require closer monitoring. This might include patients with abnormal observations, recent surgery, or known instability. Seeing these patients early helps establish a baseline and allows early identification of problems.

A practical way to do this is:

1. Write down each patient and the key tasks for the shift.
   Make a quick list of your patients and note the main things that need to be done for each one. This might include observations, wound care, medications, blood glucose checks, dressings, reviews, discharge tasks, or fluid balance monitoring. Having everything written down makes it easier to see the workload as a whole rather than trying to hold it in your head.

2. Mark the tasks that are time-critical.
   Go through your list and highlight anything that must happen at a specific time. This includes priority medications, insulin, antibiotics, scheduled observations, procedures, fasting patients, blood tests, and planned medical reviews. These tasks usually shape the structure of your shift, so they need to be identified early.

3. Identify which patients need to be seen first.
   Look at which patients are highest risk and assess them early. This may be someone with abnormal observations, new pain, recent deterioration, post-operative risk, or a patient who looked unwell on handover. Do not just start at the first bed space or the easiest patient. Start with the patient who is most likely to need you first.

4. Create a rough order for the shift, knowing it may change.
   Once you know your high-risk patients and time-critical tasks, plan the order you will do things in. For example, you might assess two higher-risk patients first, then complete medications due at 0800, then return for dressings or routine care. This gives you a working plan, rather than reacting to everything as it comes up.

5. Keep updating your written plan as the shift progresses.
   Cross off tasks as they are completed and add new tasks when they arise. If a doctor reviews a patient and orders new observations, blood tests, or treatments, write them down straight away. This helps prevent missed care and keeps your priorities visible throughout the shift.

6. Re-prioritise immediately when something changes.
   If a patient develops new chest pain, becomes hypotensive, spikes a fever, or has a sudden change in conscious state, the plan changes. Stop and work out what now takes priority. A written task list is useful, but patient condition always overrides the original plan.

7. Escalate early if the workload cannot be managed safely.
   If you can see that you will not be able to complete priority medications, assessments, or essential care safely because of competing demands, tell the nurse in charge early. Do not wait until everything is late, this can create a feeling of intense urgency to complete tasks and is where errors are likely to be made. Safe prioritisation also includes recognising when you need support.

This makes prioritisation more practical. It is not just about deciding what feels most urgent, it is about writing the workload down, identifying what is time-critical, seeing higher-risk patients early, and adjusting the plan as the shift changes.

In practice

At the start of the shift, take a few minutes to review your patients and identify who needs to be seen first. This should be based on clinical risk, not bed order or routine. If unsure, ask yourself which patient would be most at risk if not assessed early. Use a shift planner to plan the required patient care.

Throughout the shift, keep reassessing. If a patient’s condition changes, priorities should change with it. This may mean delaying other tasks or asking for support to manage competing demands.

In practice, effective prioritisation involves:

• seeing higher-risk patients early in the shift

• completing time-critical tasks within required timeframes

• reassessing priorities when patient conditions change

• escalating when something cannot be managed safely within your workload

It is also important to recognise when the workload itself is no longer manageable. If you are unable to safely prioritise due to competing demands, this should be escalated to the nurse in charge. Prioritisation does not replace the need for support.

Prioritisation improves with experience. Early on, it may feel uncertain or inconsistent, but with repeated exposure and reflection, patterns become easier to recognise. Over time, decisions become quicker, and the process becomes more natural.