CCRN Practice Test
- CCRN Test Guide
- CCRN Flash Cards
Take this free CCRN practice test to get a sample of the types of questions on the actual Critical Care Registered Nurse certification exam.
The CCRN exam is a 3 hour exam covering 150 multiple choice questions. The CCRN exams focus on three general populations: adult, pediatric and neonatal patients. Within the three general populations, the following subject categories are covered: Cardiovascular, Respiratory, Endocrine, Hematology / Immunity, Neurology, Gastrointestinal, Renal, Multisystem, Mental Health and Professional Care and Ethical Practice. Each exam is age specific and a large percentage of each test focuses on clinical judgment. A smaller percentage of each test covers professional caring and ethical practice, which can address any age in the life span, in any of the tests.
For complete practice, check out the CCRN Practice Exam Kit with 750 questions and fully explained answers. CCRN FAQ's V
 RespiratoryHematology / immunology.  GastrointestinalBehavior / psychological, multisystem, professional caring and ethical practice.
  Adult CCRN Practice TestThe Critical Care Nurses Certification (CCRN) is a certification granted by the American Association of Critical-Care Nurses (AACN). Answer the CCRN practice questions below to begin your studies! The CCRN certification shows that you have the special knowledge required for acute and critical care nursing. More than 95,000 acute and critical care nurses currently carry this certification.
Adult CCRN Test OutlineThe CCRN exam is split into two sections (clinical judgment and professional caring and ethical practice). The majority of the questions will be in the clinical judgment section. Quick Facts:
Clinical Judgment (80%)This portion of the exam consists of 5 subtopics:
Professional Caring and Ethical Practice (20%)
 Adult CCRN RequirementsIf you would like to sit for the adult CCRN exam, you must have your RN or APRN license. You must also meet 1 of these requirements:
If you would like more information about the exam, read the official CCRN handbook . Registration and FeesThere are two types of first-time certification tests available for people who want to become CCRN certified:
Computer-based testing is offered for nurses in the United States and is easy to register for. You just go online, apply for the exam, pay, schedule the exam, and pick where you would like to take it. Here is the registration link . Pen-and-paper testing is available through PSI. To apply for this test, you fill out a form and honor statement, pay the application fee, send it to the ACCN, receive the confirmation, and schedule your exam date and site. Here is a link to the different PSI testing centers . Reference the table below for fees associated with the CCRN exam.
CCRN certification is only granted for three years , so recertification tests are required to ensure the latest practices and continued knowledge are being put into practice as a CCRN. This also has a small application fee. There will be a passing point/cut score for the exam. This cut score is determined by using a modified Angoff method. A Score Evaluation Committee (SEC) will review each question and assign a difficulty rating for each question. The SEC will then work with a psychometrician to establish the cut score. The cut score is currently set at 83 for the adult CCRN exam ( source ). Studying for the Adult CCRN ExamTo help ease your mind, out of the nearly 16,000 yearly CCRN test takers around 79% of them pass the test and become CCRN certified. So, your chances of passing are good. In fact, of the 125 practical test questions (not including the 25 statistical questions for the rest of the 150), you only need to get about 83 of them correct. Here are some tips we recommend when studying for the CCRN exam:
Frequently Asked QuestionsHow many questions are on the adult ccrn exam. There are 150 total questions on the Adult CCRN exam. Of the 150 questions, 125 of them are scored. What is the time limit for the Adult CCRN exam?You will be given 3 hours to take the Adult CCRN exam. What is a passing score for the Adult CCRN exam?The cut score is currently set at 83 for the Adult CCRN exam. How much does it cost to take the Adult CCRN exam?If you are a member, you will pay $250 to take the exam. Nonmember can expect to pay $365. Does the Adult CCRN exam certification expire?The certification is good for 3 years. After 3 years, you will need to renew it. 
 Free CCRN Practice Test 2024 – 220 Critical Care Nurses QsTable of Contents At the beginning of this page, there’s a button granting complete access to the Adult Critical Care Nurses Certification (CCRN) practice test. Directly beneath it, you’ll find access to an extensive practice test designed for an in-depth review. These tests are vital for showcasing your abilities, identifying areas needing improvement, and honing your study approach. To further bolster your preparation, especially in areas needing extra focus, we have designed specialized quizzes. These are meticulously tailored to cover specific sections of the CEN exam, offering a focused and effective study session. Adult Critical Care Nurses Certification (CCRN) Domain ExamsThe Adult Critical Care Nurses Certification (CCRN) exam is a specialized test designed for nurses who provide direct care to acutely/critically ill adult patients. The CCRN certification is offered by the American Association of Critical-Care Nurses (AACN) and signifies that a nurse has attained a certain level of expertise in this area. The exam tests the knowledge required to care for patients with acute, severe, and life-threatening conditions. It is structured around specific domains of care, reflecting a comprehensive scope of acute/critical care nursing practice. Below is a breakdown of the exam domains: Domain 1: Cardiovascular
Welcome to your CCRN Domain 1: Cardiovascular  Time is Up!  Domain 2: Respiratory
Welcome to your CCRN Domain 2: Respiratory Domain 3: Endocrine/Hematology/Gastrointestinal/Renal/Integumentary
Welcome to your CCRN Domain 3: Endocrine/Hematology/Gastrointestinal/Renal/Integumentary Domain 4: Musculoskeletal/Neurological/Psychosocial
Welcome to your CCRN Domain 4: Musculoskeletal/Neurological/Psychosocial Domain 5: Multisystem
Welcome to your CCRN Domain 5: Multisystem Domain 6: Professional Caring and Ethical Practice
Welcome to your CCRN Domain 6: Professional Caring and Ethical Practice
Exam Details:
Additional Important Information:
Adult Critical Care Nurses Certification (CCRN) Exam BreakdownThe Adult Critical Care Nurses Certification (CCRN) exam is a specialized certification designed for nurses who provide direct care to acutely/critically ill adult patients. Administered by the American Association of Critical-Care Nurses (AACN), the CCRN certification is recognized as a significant credential that denotes expertise in the field of critical care nursing. The exam covers a broad range of topics necessary for the care of critically ill patients, including cardiovascular, pulmonary, endocrine, hematology/immunology, neurological, gastrointestinal, renal, and multisystem issues, as well as behavioral and psychological issues. Exam Breakdown:
Achieving the CCRN certification is a testament to a nurse’s commitment, expertise, and specialized knowledge in the field of critical care nursing. It not only enhances professional credibility but also may lead to improved job prospects, higher salaries, and greater responsibilities within the healthcare setting. How to Become CCRN Certified To become certified as an Adult Critical Care Nurse (CCRN), you must go through a process managed by the American Association of Critical-Care Nurses (AACN), which is the body responsible for the certification. Here’s a step-by-step guide to obtaining your CCRN certification, including the types of resources and links where you can find further information: 1. Meet the Eligibility RequirementsThe AACN has specific eligibility requirements for CCRN certification. These typically include:
2. Prepare for the Exam
3. Apply for the Exam
4. Schedule and Take the Exam
5. Maintain Your Certification:
Our Experience Teaching CCRN Candidates To Pass The ExamAt Career Employer, developing our Adult Critical Care Nurses Certification (CCRN) practice tests has been a remarkable endeavor, marked by significant achievements and challenges alike. Motivated by the exam’s broad spectrum of topics, our goal was to cater to the unique requirements of our learners. We have carefully crafted our approach to ensure that every student is fully equipped to excel in the exam. Our commitment to providing a comprehensive educational experience shines through in the detailed and wide-ranging content of our practice materials, highlighting our dedication to our students’ success. Teaching Adult Critical Care Nurses (CCRN) certification is a fulfilling yet challenging endeavor from a lecturer’s perspective. The CCRN certification, offered by the American Association of Critical-Care Nurses (AACN), is designed for nurses working at the bedside of acutely/critically ill patients. As an educator, the goal is not only to cover the extensive material required for the certification but also to ensure that the nurses can apply this knowledge practically, enhancing patient care quality. Key Perspectives
Teaching Resources
Educators teaching CCRN certification courses must blend their expertise in critical care nursing with effective teaching strategies to guide their students toward success. The role involves not just imparting knowledge but also inspiring confidence and competence in future critical care nurses. At Career Employer, our Adult Critical Care Nurses Certification (CCRN) certification practice tests represent the pinnacle of a dedicated effort by a team of experts, each bringing a wealth of knowledge and extensive experience in preparing candidates for the CCRN exam. Their deep understanding has successfully guided over 1000 critical care nurses to achieve their CCRN certifications, focusing specifically on the nuanced demands of medical assistants. Our team consists of experienced professionals, each with a minimum of ten years of specialized expertise in critical care nursing. This guarantees that our practice materials are not only crafted by the foremost authorities in the field but are also supremely effective in equipping candidates for success in their certification pursuits. Our unwavering dedication to quality ensures that those who use our resources are thoroughly prepared and confident in achieving their certification objectives. Effective Study Strategies and MethodsTo effectively prepare for the Adult Critical Care Nurses Certification (CCRN) exam, a comprehensive approach involving various resources and strategies is recommended. Here are some effective study strategies and resources:
The Adult Critical Care Nurses Certification (CCRN) exam costs vary depending on whether you are a member of the American Association of Critical-Care Nurses (AACN). For AACN members, the exam fee is USD 230, while non-members must pay USD 335. This information suggests there’s a significant discount for AACN members, highlighting the benefit of membership beyond the reduced exam cost, including access to continuing education and critical care journals.
This format provides a concise overview of the key points related to the CCRN exam costs and preparation, highlighting the financial aspects, available resources, eligibility criteria, and the benefits of obtaining the certification. Reliable Study Materials and ResourcesPreparing for the Adult Critical Care Nurses Certification (CCRN) certification exam can be a comprehensive process, but there are several high-quality resources available online that cater to a variety of learning preferences, from comprehensive review courses to free study guides and practice questions. Here’s a summary of some of the best resources you can utilize:
Each of these resources offers a unique approach to preparing for the CCRN certification exam. Depending on your learning style, schedule, and budget, you might find one or a combination of these resources to be particularly helpful. Tips for Exam Day
Post-Exam: Next StepsAfter passing the Adult Critical Care Nurses Certification (CCRN) exam, there are several steps and strategies you can pursue to advance your nursing career and continue your professional development.
By following these strategies, you can maximize the benefits of your CCRN certification, contribute significantly to your field, and continue to grow professionally.
Related Posts Career Employer Career Employer is the ultimate resource to help you get started working the job of your dreams. We cover topics from general career Information, career searching, exam preparation with free study materials, career interviewing and becoming successful in your career of choice. career employers editorial processHere at career employer, we focus a lot on providing factually accurate information that is always up to date. We strive to provide correct information using strict editorial processes, article editing and fact checking for all of the information found on our website. We only utilize trustworthy and relevant resources. To find out more, make sure to read our full editorial process page here . Leave a Comment Cancel replyNotify me via e-mail if anyone answers my comment. About Career Employer Contact Career Employer Editorial Process Privacy Policy  Connect with us [email protected] (206) 809-7331 Hours of Operation: 10am – 8pm M-F (PST) 7511 Greenwood Ave North Unit #4300 Seattle, WA 98103 © Copyright 2024, Career Employer CCRN Practice TestWelcome to your CCRN Practice Test How Career Employer Collects Its Data
Critical Care Nursing Questions and Answers with RationaleCritical care nursing questions and answers part 1. 1) A nurse has developed a nursing diagnosis of ineffective airway clearance for a client who sustained an inhalation burn injury. Which of the following nursing intervention should include in the plan of care for this client? a. Monitor oxygen saturation every 4 hrs. b. Encourage coughing and deep breathing every 4 hrs. c. Elevate the head of bed d. Asses respiratory rate and breath sounds every 4 hrs. 2) A client who is involved in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates which intravenous solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss and increase blood pressure? a. 5%D in lactated Ringer’s solution b. 0.33%normal saline c. 0.225%normal saline d. 0.45%normal saline 3) A nurse in the telemetry unit is monitoring a client for cardiac changes indicative of hypokalemia. Which of the following if noted in cardiac monitor, would indicate the presence of hypokalemia? a. Tall, peaked T wave b. ST segment depression c. Widening QRS complex d. Prolonged PR interval 4) A nurse is performing cardiopulmonary resuscitation (CPR)on a client who has had a cardiac arrest. An automatic external defibrillator is available to treat the client. Which of the following activities will allow the nurse to assess the client’s cardiac rhythm? a. Hold the defibrillator paddles firmly against the chest b. Apply adhesive patch electrodes to the chest and move away from the client c. Apply standard ECG monitoring leads to the client and observe the rhythm d. Connect standard ECG electrodes to a trans telephonic monitor 5) A client who sustained an inhalation injury arrives in ER. On initial assessment the nurse notes that the client is very confused and combative. The nurse determines that the client is most likely experiencing? a. Anxiety b. Fear c. Pain d. Hypoxia 6) A nurse attempts to relieve an airway obstruction on a 3year old conscious child. The nurse performs this maneuver correctly by standing behind the child, placing her arms under the client’s axillae and around the client and positioning her hands to deliver thrusts between. a. Groin and the abdomen b. Umbilicus and the groin c. Lower abdomen and the chest d. Umbilicus and the xiphoid process 7) The ER nurse is monitoring a client who received treatment for a severe asthma attack. The nurse determines that the client’s respiratory status had worsened if which of the following is noted on assessment? a. Diminished breath sounds b. Wheezing during inhalation c. Wheezing during exhalation d. Wheezing throughout the lung fields 8)The nurse is performing CPR on a 7year old child. The nurse delivers how many breaths per minute the child? a. 6 b. 8 c. 10 d. 20 9) A client in cardiogenic shock has a pulmonary artery catheter (Swan-Ganz type) placed. The nurse would interpret which of the following cardiac output (CO)and pulmonary capillary wedge pressure (PCWP) readings as indicating that the client is most unstable? a. CO 5l/min PCWP low b. CO 2l/min PCWP low c. CO 4l/min PCWP high d. CO 3l/min PCWP high 10)A client is undergoing fluid replacement after burned on 20% of her body 12 hr. ago. The nursing assessment reveals a Blood pressure of 90/50mmHg, Pulse rate of 110b/t, and urine output of 20ml/hr. The nurse reports the findings to the physician and anticipates which of the following prescriptions? a. Transfusing One packed red blood cells b. Administering a diuretic to increase the urine output c. Increasing the amount of IV Lactated Ringer’s solution d. Changing the IV lactated Ringer’s solution to dextrose in water 11) A nurse is performing an assessment on a client who was admitted to the hospital with a diagnosis of carbon monoxide poisoning. Which of the following assessments performed by the nurse would primarily elicit data related to a deterioration of the client’s condition? a. Skin color b. Apical rate c. Respiratory rate d. Level of consciousness 12)A nurse suspects that a pulmonary embolism has developed in a postpartum client with femoral thrombophlebitis. The immediate nursing action would be to: a. Monitor vital signs b. Elevate the head of the bed 30 to 40degrees c. Initiate an intravenous line if one is not already in place d. Administer oxygen by face mask as prescribed at 8-10l/min 13)A nurse is planning care for a client with intracranial pressure (ICP) monitoring. Which of the following interventions would be contraindicated in the plan of care? a. Using strict aseptic technique when touching the monitoring system b. Assessing the insertion site for signs and symptoms of infection c. Leveling the transducer at the lowest point of the ear d. Checking all stopcocks and connections for leaks 14) A client with a history of silicosis is admitted to the hospital with respiratory distress and impending respiratory failure. The nurse plans to have which of the following items readily available at the client’s bedside? a. Chest tube drainage system b. Intubation tray c. Thoracentesis tray d. Crash cart 15) A client in shock is receiving dopamine hydrochloride by intravenous infusion. The nurse should have which of the following medications available for local injection if IV infiltration and medication extravasation occur? a. Vitamin K b. Phentolamine c. Atropine sulphate d. Protamine sulphate Obstetrics and Gynecology Nursing Questions and Answers Please Subscribe Our YouTube channel – The Nurse Like our Facebook Page: The Nurse  Hello Learners, Aiming to crack CSIR NET 2021? Then a Complete Course for Life Sciences is starting from 1st Feb. Get your subscription today before the price hike. Click Here for Subscription
 Critical Care Nursing QuizMore actions.
Questions and AnswersWhere can critical care nurses be found working.
What is another term for critical care nurses?
What kind of patients do critical care nurses treat?
What type of care do critically ill patients require?<p>Life sustaining technology and drugs</p> Signup and view all the answers What kind of ventilation might critically ill patients require?<p>Mechanical ventilation by way of endotracheal intubation</p> Signup and view all the answers Study NotesWork environments for critical care nurses.
Alternate Term for Critical Care Nurses
Patient Demographics
Required Care for Critically Ill Patients
Ventilation Needs for Critically Ill Patients
Studying That Suits YouUse AI to generate personalized quizzes and flashcards to suit your learning preferences. DescriptionTest your knowledge of critical care nursing with this quiz! Explore topics such as patient assessment, emergency interventions, and specialized care for critically ill patients. Challenge yourself with questions about intensive care unit (ICU) nursing and the unique skills required in this high-stakes field. More Quizzes Like This Mastering Critical Nursing Care Goals of Critical Care Nursing Nursing Prioritization: Critical Thinking, Triage, Ethics, Time Manage... Critical Care Nursing Essentials Upgrade to continueToday's Special Offer Save an additional 20% with coupon: SAVE20 Upgrade to a paid plan to continue Trusted by top students and educators worldwide  We are constantly improving Quizgecko and would love to hear your feedback. You can also submit feature requests here: feature requests. Create your free account By continuing, you agree to Quizgecko's Terms of Service and Privacy Policy .
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See full indexLearn critical care.  Critical Care IBy: brittany blackston.  Critical Care Med SurgBy: giselle alvarez, respiratory physiology, medicine and critical care, by: marc place.  Critical Care Board ReviewBy: rodney steff.  Module 7 (Critical Care)By: madison north.  ABIM Critical CareBy: jim flanagan, critical care, by: kelsey klipfel, by: katy peterson, critical care nursing, by: chantelle smith.  critical careBy: hailey dlugolinski.  Critical Care 1By: beatrice dunnavan, by: savannah moss, critical care flight paramedic, by: al townsend.  Critical Care BoardsBy: martin gibbs, critical care 2, back to basics - critical care transport review, by: ian berghorn, by: jena clark, critical care paramedic, by: james stratton.  EM Critical CareCritical care test 1, by: amanda silva, by: julia mohler, emergency critical care vts, by: christina lee.  By: jorden fliegCritical care fp-c 2.0, by: dalton farrer, by: savannah buchanan.  By: Kaitlin HobbsBy: lexie schoenrock, by: hannah espanioly, critical care paramedic review, royal college critical care, by: marko balan, knowledge genome.
ICU Related MCQ Quiz Welcome to our ICU Related MCQ Quiz, specially crafted to challenge your knowledge and understanding of critical care concepts. This quiz is designed for healthcare professionals working in the intensive care unit (ICU), including nurses, physicians, and allied healthcare providers. In this quiz, you'll encounter a variety of multiple-choice questions covering a wide range of topics relevant to ICU practice. From ventilator management and hemodynamic monitoring to pharmacology and emergency procedures, our questions aim to assess your proficiency in critical care management. Each question is accompanied by detailed explanations and references, allowing you to expand your knowledge base Read more and reinforce key concepts. Get ready to challenge yourself and see how much you know about critical care! Let's dive in and see if you're an ICU expert! ICU Questions and AnswersA patient who has an inhalation injury comes to the er. on the initial assessment, the nurse notes that the patient is very confused and physically defensive. what do you think the client may be experiencing . Anxiety Rate this question: The patient has vomiting that is very similar to coffee grounds. Where can the location of the bleeding be?Large Intestine (colon) Small Intestine Upper GI Tract A patient who has been admitted with a gastric ulcer now develops severe epigastric pain that spreads over the entire abdomen. He is very pale and is lying on his side. What should be the nurse's immediate action?Notify the doctor and check the vitals. Immediately administer opioids. Perform deep palpations on the abdomen. Reposition the patient In Semi-Fowler's Position. A patient has a diagnosis of ineffective airway clearance. He has sustained an inhalation burn injury. Amongst the following nursing interventions, which of the following is the most rational?Encourage coughing every 4 hours. Elevate the head of the bed. Monitor respiratory rate and breathing every 4 hours. Monitor oxygen levels every 4 hours. The patient has aphasia, decreased levels of consciousness & weakness in the right side of the body. There is a history of heart disease, ischemic attacks, and hyperlipidemia. Based on the medical history, what type of stroke could it be?Hemorrhagic Stroke Ischemic Stroke Subarachnoid Hemorrhages Intracerebral Hemorrhages A patient has been admitted with an ischemic stroke. She was given a recombinant tissue plasminogen activator (rtPA) in the ER. Which of the following medication she shouldn't be given?Sodium Nitroprusside All of the above Which nursing intervention can help prevent sharp spikes in ICP and surgical hemorrhage?Give fluid restriction. Help with breathing exercises. Keep the head of the bed elevated. Administer an antiemetic to prevent vomiting. What is the order of the abdominal assessment?Inspection, percussion, auscultation, palpation Inspection, auscultation, percussion, palpation Inspection, palpation, percussion, auscultation Inspection, percussion, palpation, auscultation The patient has a risk of GI hemorrhage. For which of the critical symptoms should the patient be monitored?Hyperkalemia and hypernatremia Hematemesis and melena Decreasing hemoglobin levels Metabolic acidosis and hypovolemia Which of the following statements is true for acute liver damage?The main reason for acute liver failure is chronic liver damage. Metabolic alkalosis is the common indicator of acute liver damage. It might lead to cardiac dysrhythmias and respiratory failure. None of the statements is true. The patient has acute liver disease. Which lab values are true with his condition?Increased ammonia levels Decreased PT Decreased AST and ALT None of the above What is the physiological alteration of acute pancreatitis?Hyperglycemia Premature activation of inactive digestive enzymes Destruction of RBC Respiratory issues A person with a 10-year history of severe alcoholism was admitted to the ER. He got the diagnosis of acute pancreatitis. Based on the recent diagnosis, what could be true about the patient?Should be started feeding Requires to be monitored for hyperglycemia The patient is at the risk for hypovolemic shock Should be placed on fluid restriction Esophageal varices can be caused due to __________.Portal hypertension Inflammation Superficial mucosal erosions Pro-ulcer forces breaking down Quiz Review Timeline + Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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 Related Quizzes Wait! Here's an interesting quiz for you.  CCRN Adult – Critical Care Nursing Adult Exam ReviewThe American Association of Critical-Care Nurses (AACN) offers critical care nurses an opportunity to validate their skills and knowledge through certification examination. The Critical Care Nursing Certification (CCRN) is for registered nurses who provide direct patient care to acutely/critically ill adult, pediatric, and neonatal patients. There are three specialty topics of the CCRN: Adult CCRN, Pediatric CCRN, and Neonatal CCRN. This article highlights the Adult CCRN examination and the eligibility, design, and delivery of the certification. CCRN Adult Exam Study Guide and Flashcards Get practice questions, detailed study lessons, and complex subjects broken down into easily understandable concepts.  EligibilityEligibility to sit for the CCRN examination includes:
Application methodsPaper application. The paper application is for group registrations, individuals wishing to take the paper and pencil exam, and those who are testing outside of the United States. Complete the registration form found in the CCRN manual, including the application fee, and allow two to three weeks for processing. Online applicationRegister online at the AACN website. Complete the registration information and submit the application fee. Your registration is processed 24 hours a day, seven days a week. Scheduling of your examSuccessful applicants receive an email confirmation from AACN. Within five to ten days after receipt of the confirmation email, you will receive an approval-to-test postcard and email from the testing service. Follow the directions in the approval to schedule your exam. You have 90 days from receipt of the authorization to schedule your certification with the testing center. The exam is offered twice a day, Monday through Friday, at over 300 testing facilities nationwide. The application fee is payable in U.S. funds by Visa, MasterCard, American Express, or Discover Card. Check or money order is available for mail-in applications. The application fee is $235.00 for AACN members and $340.00 for non-members. Online CCRN Adult Prep CourseIf you want to be fully prepared, Mometrix offers an online CCRN Adult Prep Course. The course is designed to provide you with any and every resource you might want while studying. The CCRN Adult Course includes:
The CCRN Adult Prep Course is designed to help any learner get everything they need to prepare for their CCRN exam; click below to check it out.
 Test designBased on AACN’s Synergy Model for Patient Care, the exam assesses your ability to integrate your knowledge, skills, and abilities delivering acute/critically ill patient care. Consisting of 150 multiple-choice questions, examined subject matter covers clinical judgment (80%), and professional caring and ethical practice (20%). The exam assesses your integration of knowledge, skills, abilities, and experience delivering direct pediatric patient care and consists of 150 multiple-choice questions. The test contains questions covering clinical judgment (80%) and professional caring and ethical practice (20%) based on AACN’s Synergy Model for Patient Care. The clinical judgment content has five sections:
Twenty percent of the exam questions are drawn from the following areas:
The skills, knowledge, and abilities assessed include your clinical judgment, advocacy/moral agency, caring practices, collaboration, systems thinking, response to diversity, facilitation of learning, and clinical inquiry. Regardless of the test-delivery method (computer or pen and pencil), you have three hours to complete the exam. Arrive on time for your testing appointment and leave your personal belongings at home or in your car. Two valid forms of identification are required when you check-in, and you are not allowed to bring anything with you into the testing center. At your testing station, all materials needed for the exam are provided, and you have an opportunity to take a familiarization pre-test before beginning your exam. After the pre-test, your exam begins. During the exam, you can annotate questions to review. Try not to spend too much time on each item, so you have time to double-check your work. When you have completed the exam, and you are satisfied with your responses, submit your exam for evaluation, and report to the test proctor for your score report. Your score report indicates your pass or fail status with information on your performance in each content area. The passing score is determined by a standard that is based on the difficulty of the exam. If you did not pass the exam on your first attempts, you can retake the exam at a discounted rate. Four weeks after your testing window closes, AACN will mail your certificate. Preparing for the examThe Adult Critical Care Nursing Certification identifies you as a care provider with specialized knowledge and experience required to provide acute and critical care to patients at a highly-skilled and experienced level. CCRN certification can lead to increased responsibility, career advancement, and personal satisfaction. Only 79% of CCRN examinees pass on their first attempt. The exam is comprehensive and intense, and guidance on developing your study plan will help you succeed on your first try. Use Mometrix Test Preparation’s study guide , flashcards , and Online Course , to direct your studies. The study guide, flashcards, and Online Course cover each topic, vocabulary word, and characteristics included in the CCRN exam. A 100% money-back guarantee ensures your satisfaction.
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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022.  Nursing Management and Professional Concepts [Internet].
Chapter 2 - Prioritization2.1. prioritization introduction, learning objectives. • Prioritize nursing care based on patient acuity • Use principles of time management to organize work • Analyze effectiveness of time management strategies • Use critical thinking to prioritize nursing care for patients • Apply a framework for prioritization (e.g., Maslow, ABCs) “So much to do, so little time.” This is a common mantra of today’s practicing nurse in various health care settings. Whether practicing in acute inpatient care, long-term care, clinics, home care, or other agencies, nurses may feel there is “not enough of them to go around.” The health care system faces a significant challenge in balancing the ever-expanding task of meeting patient care needs with scarce nursing resources that has even worsened as a result of the COVID-19 pandemic. With a limited supply of registered nurses, nurse managers are often challenged to implement creative staffing practices such as sending staff to units where they do not normally work (i.e., floating), implementing mandatory staffing and/or overtime, utilizing travel nurses, or using other practices to meet patient care demands.[ 1 ] Staffing strategies can result in nurses experiencing increased patient assignments and workloads, extended shifts, or temporary suspension of paid time off. Nurses may receive a barrage of calls and text messages offering “extra shifts” and bonus pay, and although the extra pay may be welcomed, they often eventually feel burnt out trying to meet the ever-expanding demands of the patient-care environment. A novice nurse who is still learning how to navigate the complex health care environment and provide optimal patient care may feel overwhelmed by these conditions. Novice nurses frequently report increased levels of stress and disillusionment as they transition to the reality of the nursing role.[ 2 ] How can we address this professional dilemma and enhance the novice nurse’s successful role transition to practice? The novice nurse must enter the profession with purposeful tools and strategies to help prioritize tasks and manage time so they can confidently address patient care needs, balance role demands, and manage day-to-day nursing activities. Let’s take a closer look at the foundational concepts related to prioritization and time management in the nursing profession. 2.2. TENETS OF PRIORITIZATIONPrioritization. As new nurses begin their career, they look forward to caring for others, promoting health, and saving lives. However, when entering the health care environment, they often discover there are numerous and competing demands for their time and attention. Patient care is often interrupted by call lights, rounding physicians, and phone calls from the laboratory department or other interprofessional team members. Even individuals who are strategic and energized in their planning can feel frustrated as their task lists and planned patient-care activities build into a long collection of “to dos.” Without utilization of appropriate prioritization strategies, nurses can experience time scarcity , a feeling of racing against a clock that is continually working against them. Functioning under the burden of time scarcity can cause feelings of frustration, inadequacy, and eventually burnout. Time scarcity can also impact patient safety, resulting in adverse events and increased mortality.[ 1 ] Additionally, missed or rushed nursing activities can negatively impact patient satisfaction scores that ultimately affect an institution’s reimbursement levels. It is vital for nurses to plan patient care and implement their task lists while ensuring that critical interventions are safely implemented first. Identifying priority patient problems and implementing priority interventions are skills that require ongoing cultivation as one gains experience in the practice environment.[ 2 ] To develop these skills, students must develop an understanding of organizing frameworks and prioritization processes for delineating care needs. These frameworks provide structure and guidance for meeting the multiple and ever-changing demands in the complex health care environment. Let’s consider a clinical scenario in the following box to better understand the implications of prioritization and outcomes. Imagine you are beginning your shift on a busy medical-surgical unit. You receive a handoff report on four medical-surgical patients from the night shift nurse: • Patient A is a 34-year-old total knee replacement patient, post-op Day 1, who had an uneventful night. It is anticipated that she will be discharged today and needs patient education for self-care at home. • Patient B is a 67-year-old male admitted with weakness, confusion, and a suspected urinary tract infection. He has been restless and attempting to get out of bed throughout the night. He has a bed alarm in place. • Patient C is a 49-year-old male, post-op Day 1 for a total hip replacement. He has been frequently using his patient-controlled analgesia (PCA) pump and last rated his pain as a “6.” • Patient D is a 73-year-old male admitted for pneumonia. He has been hospitalized for three days and receiving intravenous (IV) antibiotics. His next dose is due in an hour. His oxygen requirements have decreased from 4 L/minute of oxygen by nasal cannula to 2 L/minute by nasal cannula. Based on the handoff report you received, you ask the nursing assistant to check on Patient B while you do an initial assessment on Patient D. As you are assessing Patient D’s oxygenation status, you receive a phone call from the laboratory department relating a critical lab value on Patient C, indicating his hemoglobin is low. The provider calls and orders a STAT blood transfusion for Patient C. Patient A rings the call light and states she and her husband have questions about her discharge and are ready to go home. The nursing assistant finds you and reports that Patient B got out of bed and experienced a fall during the handoff reports. It is common for nurses to manage multiple and ever-changing tasks and activities like this scenario, illustrating the importance of self-organization and priority setting. This chapter will further discuss the tools nurses can use for prioritization. 2.3. TOOLS FOR PRIORITIZINGPrioritization of care for multiple patients while also performing daily nursing tasks can feel overwhelming in today’s fast-paced health care system. Because of the rapid and ever-changing conditions of patients and the structure of one’s workday, nurses must use organizational frameworks to prioritize actions and interventions. These frameworks can help ease anxiety, enhance personal organization and confidence, and ensure patient safety. Acuity and intensity are foundational concepts for prioritizing nursing care and interventions. Acuity refers to the level of patient care that is required based on the severity of a patient’s illness or condition. For example, acuity may include characteristics such as unstable vital signs, oxygenation therapy, high-risk IV medications, multiple drainage devices, or uncontrolled pain. A “high-acuity” patient requires several nursing interventions and frequent nursing assessments. Intensity addresses the time needed to complete nursing care and interventions such as providing assistance with activities of daily living (ADLs), performing wound care, or administering several medication passes. For example, a “high-intensity” patient generally requires frequent or long periods of psychosocial, educational, or hygiene care from nursing staff members. High-intensity patients may also have increased needs for safety monitoring, familial support, or other needs.[ 1 ] Many health care organizations structure their staffing assignments based on acuity and intensity ratings to help provide equity in staff assignments. Acuity helps to ensure that nursing care is strategically divided among nursing staff. An equitable assignment of patients benefits both the nurse and patient by helping to ensure that patient care needs do not overwhelm individual staff and safe care is provided. Organizations use a variety of systems when determining patient acuity with rating scales based on nursing care delivery, patient stability, and care needs. See an example of a patient acuity tool published in the American Nurse in Table 2.3 .[ 2 ] In this example, ratings range from 1 to 4, with a rating of 1 indicating a relatively stable patient requiring minimal individualized nursing care and intervention. A rating of 2 reflects a patient with a moderate risk who may require more frequent intervention or assessment. A rating of 3 is attributed to a complex patient who requires frequent intervention and assessment. This patient might also be a new admission or someone who is confused and requires more direct observation. A rating of 4 reflects a high-risk patient. For example, this individual may be experiencing frequent changes in vital signs, may require complex interventions such as the administration of blood transfusions, or may be experiencing significant uncontrolled pain. An individual with a rating of 4 requires more direct nursing care and intervention than a patient with a rating of 1 or 2. [3] Example of a Patient Acuity Tool [ 4 ] View in own window
Read more about using a patient acuity tool on a medical-surgical unit. Rating scales may vary among institutions, but the principles of the rating system remain the same. Organizations include various patient care elements when constructing their staffing plans for each unit. Read more information about staffing models and acuity in the following box. Staffing Models and AcuityOrganizations that base staffing on acuity systems attempt to evenly staff patient assignments according to their acuity ratings. This means that when comparing patient assignments across nurses on a unit, similar acuity team scores should be seen with the goal of achieving equitable and safe division of workload across the nursing team. For example, one nurse should not have a total acuity score of 6 for their patient assignments while another nurse has a score of 15. If this situation occurred, the variation in scoring reflects a discrepancy in workload balance and would likely be perceived by nursing peers as unfair. Using acuity-rating staffing models is helpful to reflect the individualized nursing care required by different patients. Alternatively, nurse staffing models may be determined by staffing ratio. Ratio-based staffing models are more straightforward in nature, where each nurse is assigned care for a set number of patients during their shift. Ratio-based staffing models may be useful for administrators creating budget requests based on the number of staff required for patient care, but can lead to an inequitable division of work across the nursing team when patient acuity is not considered. Increasingly complex patients require more time and interventions than others, so a blend of both ratio and acuity-based staffing is helpful when determining staffing assignments.[ 5 ] As a practicing nurse, you will be oriented to the elements of acuity ratings within your health care organization, but it is also important to understand how you can use these acuity ratings for your own prioritization and task delineation. Let’s consider the Scenario B in the following box to better understand how acuity ratings can be useful for prioritizing nursing care. You report to work at 6 a.m. for your nursing shift on a busy medical-surgical unit. Prior to receiving the handoff report from your night shift nursing colleagues, you review the unit staffing grid and see that you have been assigned to four patients to start your day. The patients have the following acuity ratings: Patient A: 45-year-old patient with paraplegia admitted for an infected sacral wound, with an acuity rating of 4. Patient B: 87-year-old patient with pneumonia with a low grade fever of 99.7 F and receiving oxygen at 2 L/minute via nasal cannula, with an acuity rating of 2. Patient C: 63-year-old patient who is postoperative Day 1 from a right total hip replacement and is receiving pain management via a PCA pump, with an acuity rating of 2. Patient D: 83-year-old patient admitted with a UTI who is finishing an IV antibiotic cycle and will be discharged home today, with an acuity rating of 1. Based on the acuity rating system, your patient assignment load receives an overall acuity score of 9. Consider how you might use their acuity ratings to help you prioritize your care. Based on what is known about the patients related to their acuity rating, whom might you identify as your care priority? Although this can feel like a challenging question to answer because of the many unknown elements in the situation using acuity numbers alone, Patient A with an acuity rating of 4 would be identified as the care priority requiring assessment early in your shift. Although acuity can a useful tool for determining care priorities, it is important to recognize the limitations of this tool and consider how other patient needs impact prioritization. Maslow’s Hierarchy of Needs When thinking back to your first nursing or psychology course, you may recall a historical theory of human motivation based on various levels of human needs called Maslow’s Hierarchy of Needs. Maslow’s Hierarchy of Needs reflects foundational human needs with progressive steps moving towards higher levels of achievement. This hierarchy of needs is traditionally represented as a pyramid with the base of the pyramid serving as essential needs that must be addressed before one can progress to another area of need.[ 6 ] See Figure 2.1 [ 7 ] for an illustration of Maslow’s Hierarchy of Needs. Maslow’s Hierarchy of Needs places physiological needs as the foundational base of the pyramid.[ 8 ] Physiological needs include oxygen, food, water, sex, sleep, homeostasis, and excretion. The second level of Maslow’s hierarchy reflects safety needs. Safety needs include elements that keep individuals safe from harm. Examples of safety needs in health care include fall precautions. The third level of Maslow’s hierarchy reflects emotional needs such as love and a sense of belonging. These needs are often reflected in an individual’s relationships with family members and friends. The top two levels of Maslow’s hierarchy include esteem and self-actualization. An example of addressing these needs in a health care setting is helping an individual build self-confidence in performing blood glucose checks that leads to improved self-management of their diabetes. So how does Maslow’s theory impact prioritization? To better understand the application of Maslow’s theory to prioritization, consider Scenario C in the following box. You are an emergency response nurse working at a local shelter in a community that has suffered a devastating hurricane. Many individuals have relocated to the shelter for safety in the aftermath of the hurricane. Much of the community is still without electricity and clean water, and many homes have been destroyed. You approach a young woman who has a laceration on her scalp that is bleeding through her gauze dressing. The woman is weeping as she describes the loss of her home stating, “I have lost everything! I just don’t know what I am going to do now. It has been a day since I have had water or anything to drink. I don’t know where my sister is, and I can’t reach any of my family to find out if they are okay!” Despite this relatively brief interaction, this woman has shared with you a variety of needs. She has demonstrated a need for food, water, shelter, homeostasis, and family. As the nurse caring for her, it might be challenging to think about where to begin her care. These thoughts could be racing through your mind: Should I begin to make phone calls to try and find her family? Maybe then she would be able to calm down. Should I get her on the list for the homeless shelter so she wouldn’t have to worry about where she will sleep tonight? She hasn’t eaten in awhile; I should probably find her something to eat. All of these needs are important and should be addressed at some point, but Maslow’s hierarchy provides guidance on what needs must be addressed first. Use the foundational level of Maslow’s pyramid of physiological needs as the top priority for care. The woman is bleeding heavily from a head wound and has had limited fluid intake. As the nurse caring for this patient, it is important to immediately intervene to stop the bleeding and restore fluid volume. Stabilizing the patient by addressing her physiological needs is required before undertaking additional measures such as contacting her family. Imagine if instead you made phone calls to find the patient’s family and didn’t address the bleeding or dehydration – you might return to a severely hypovolemic patient who has deteriorated and may be near death. In this example, prioritizing emotional needs above physiological needs can lead to significant harm to the patient. Although this is a relatively straightforward example, the principles behind the application of Maslow’s hierarchy are essential. Addressing physiological needs before progressing toward additional need categories concentrates efforts on the most vital elements to enhance patient well-being. Maslow’s hierarchy provides the nurse with a helpful framework for identifying and prioritizing critical patient care needs. Airway, breathing, and circulation, otherwise known by the mnemonic “ABCs,” are another foundational element to assist the nurse in prioritization. Like Maslow’s hierarchy, using the ABCs to guide decision-making concentrates on the most critical needs for preserving human life. If a patient does not have a patent airway, is unable to breathe, or has inadequate circulation, very little of what else we do matters. The patient’s ABCs are reflected in Maslow’s foundational level of physiological needs and direct critical nursing actions and timely interventions. Let’s consider Scenario D in the following box regarding prioritization using the ABCs and the physiological base of Maslow’s hierarchy. You are a nurse on a busy cardiac floor charting your morning assessments on a computer at the nurses’ station. Down the hall from where you are charting, two of your assigned patients are resting comfortably in Room 504 and Room 506. Suddenly, both call lights ring from the rooms, and you answer them via the intercom at the nurses’ station. Room 504 has an 87-year-old male who has been admitted with heart failure, weakness, and confusion. He has a bed alarm for safety and has been ringing his call bell for assistance appropriately throughout the shift. He requires assistance to get out of bed to use the bathroom. He received his morning medications, which included a diuretic about 30 minutes previously, and now reports significant urge to void and needs assistance to the bathroom. Room 506 has a 47-year-old woman who was hospitalized with new onset atrial fibrillation with rapid ventricular response. The patient underwent a cardioversion procedure yesterday that resulted in successful conversion of her heart back into normal sinus rhythm. She is reporting via the intercom that her “heart feels like it is doing that fluttering thing again” and she is having chest pain with breathlessness. Based upon these two patient scenarios, it might be difficult to determine whom you should see first. Both patients are demonstrating needs in the foundational physiological level of Maslow’s hierarchy and require assistance. To prioritize between these patients’ physiological needs, the nurse can apply the principles of the ABCs to determine intervention. The patient in Room 506 reports both breathing and circulation issues, warning indicators that action is needed immediately. Although the patient in Room 504 also has an urgent physiological elimination need, it does not overtake the critical one experienced by the patient in Room 506. The nurse should immediately assess the patient in Room 506 while also calling for assistance from a team member to assist the patient in Room 504. Prioritizing what should be done and when it can be done can be a challenging task when several patients all have physiological needs. Recently, there has been professional acknowledgement of the cognitive challenge for novice nurses in differentiating physiological needs. To expand on the principles of prioritizing using the ABCs, the CURE hierarchy has been introduced to help novice nurses better understand how to manage competing patient needs. The CURE hierarchy uses the acronym “CURE” to guide prioritization based on identifying the differences among Critical needs, Urgent needs, Routine needs, and Extras.[ 9 ] “Critical” patient needs require immediate action. Examples of critical needs align with the ABCs and Maslow’s physiological needs, such as symptoms of respiratory distress, chest pain, and airway compromise. No matter the complexity of their shift, nurses can be assured that addressing patients’ critical needs is the correct prioritization of their time and energies. After critical patient care needs have been addressed, nurses can then address “urgent” needs. Urgent needs are characterized as needs that cause patient discomfort or place the patient at a significant safety risk.[ 10 ] The third part of the CURE hierarchy reflects “routine” patient needs. Routine patient needs can also be characterized as “typical daily nursing care” because the majority of a standard nursing shift is spent addressing routine patient needs. Examples of routine daily nursing care include actions such as administering medication and performing physical assessments.[ 11 ] Although a nurse’s typical shift in a hospital setting includes these routine patient needs, they do not supersede critical or urgent patient needs. The final component of the CURE hierarchy is known as “extras.” Extras refer to activities performed in the care setting to facilitate patient comfort but are not essential.[ 12 ] Examples of extra activities include providing a massage for comfort or washing a patient’s hair. If a nurse has sufficient time to perform extra activities, they contribute to a patient’s feeling of satisfaction regarding their care, but these activities are not essential to achieve patient outcomes. Let’s apply the CURE mnemonic to patient care in the following box. If we return to Scenario D regarding patients in Room 504 and 506, we can see the patient in Room 504 is having urgent needs. He is experiencing a physiological need to urgently use the restroom and may also have safety concerns if he does not receive assistance and attempts to get up on his own because of weakness. He is on a bed alarm, which reflects safety considerations related to his potential to get out of bed without assistance. Despite these urgent indicators, the patient in Room 506 is experiencing a critical need and takes priority. Recall that critical needs require immediate nursing action to prevent patient deterioration. The patient in Room 506 with a rapid, fluttering heartbeat and shortness of breath has a critical need because without prompt assessment and intervention, their condition could rapidly decline and become fatal. In addition to using the identified frameworks and tools to assist with priority setting, nurses must also look at their patients’ data cues to help them identify care priorities. Data cues are pieces of significant clinical information that direct the nurse toward a potential clinical concern or a change in condition. For example, have the patient’s vital signs worsened over the last few hours? Is there a new laboratory result that is concerning? Data cues are used in conjunction with prioritization frameworks to help the nurse holistically understand the patient’s current status and where nursing interventions should be directed. Common categories of data clues include acute versus chronic conditions, actual versus potential problems, unexpected versus expected conditions, information obtained from the review of a patient’s chart, and diagnostic information. Acute Versus Chronic ConditionsA common data cue that nurses use to prioritize care is considering if a condition or symptom is acute or chronic. Acute conditions have a sudden and severe onset. These conditions occur due to a sudden illness or injury, and the body often has a significant response as it attempts to adapt. Chronic conditions have a slow onset and may gradually worsen over time. The difference between an acute versus a chronic condition relates to the body’s adaptation response. Individuals with chronic conditions often experience less symptom exacerbation because their body has had time to adjust to the illness or injury. Let’s consider an example of two patients admitted to the medical-surgical unit complaining of pain in Scenario E in the following box. As part of your patient assignment on a medical-surgical unit, you are caring for two patients who both ring the call light and report pain at the start of the shift. Patient A was recently admitted with acute appendicitis, and Patient B was admitted for observation due to weakness. Not knowing any additional details about the patients’ conditions or current symptoms, which patient would receive priority in your assessment? Based on using the data cue of acute versus chronic conditions, Patient A with a diagnosis of acute appendicitis would receive top priority for assessment over a patient with chronic pain due to osteoarthritis. Patients experiencing acute pain require immediate nursing assessment and intervention because it can indicate a change in condition. Acute pain also elicits physiological effects related to the stress response, such as elevated heart rate, blood pressure, and respiratory rate, and should be addressed quickly. Actual Versus Potential ProblemsNursing diagnoses and the nursing care plan have significant roles in directing prioritization when interpreting assessment data cues. Actual problems refer to a clinical problem that is actively occurring with the patient. A risk problem indicates the patient may potentially experience a problem but they do not have current signs or symptoms of the problem actively occurring. Consider an example of prioritizing actual and potential problems in Scenario F in the following box. A 74-year-old woman with a previous history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital for pneumonia. She has generalized weakness, a weak cough, and crackles in the bases of her lungs. She is receiving IV antibiotics, fluids, and oxygen therapy. The patient can sit at the side of the bed and ambulate with the assistance of staff, although she requires significant encouragement to ambulate. Nursing diagnoses are established for this patient as part of the care planning process. One nursing diagnosis for this patient is Ineffective Airway Clearance . This nursing diagnosis is an actual problem because the patient is currently exhibiting signs of poor airway clearance with an ineffective cough and crackles in the lungs. Nursing interventions related to this diagnosis include coughing and deep breathing, administering nebulizer treatment, and evaluating the effectiveness of oxygen therapy. The patient also has the nursing diagnosis Risk for Skin Breakdown based on her weakness and lack of motivation to ambulate. Nursing interventions related to this diagnosis include repositioning every two hours and assisting with ambulation twice daily. The established nursing diagnoses provide cues for prioritizing care. For example, if the nurse enters the patient’s room and discovers the patient is experiencing increased shortness of breath, nursing interventions to improve the patient’s respiratory status receive top priority before attempting to get the patient to ambulate. Although there may be times when risk problems may supersede actual problems, looking to the “actual” nursing problems can provide clues to assist with prioritization. Unexpected Versus Expected ConditionsIn a similar manner to using acute versus chronic conditions as a cue for prioritization, it is also important to consider if a client’s signs and symptoms are “expected” or “unexpected” based on their overall condition. Unexpected conditions are findings that are not likely to occur in the normal progression of an illness, disease, or injury. Expected conditions are findings that are likely to occur or are anticipated in the course of an illness, disease, or injury. Unexpected findings often require immediate action by the nurse. Let’s apply this tool to the two patients previously discussed in Scenario E. As you recall, both Patient A (with acute appendicitis) and Patient B (with weakness and diagnosed with osteoarthritis) are reporting pain. Acute pain typically receives priority over chronic pain. But what if both patients are also reporting nausea and have an elevated temperature? Although these symptoms must be addressed in both patients, they are “expected” symptoms with acute appendicitis (and typically addressed in the treatment plan) but are “unexpected” for the patient with osteoarthritis. Critical thinking alerts you to the unexpected nature of these symptoms in Patient B, so they receive priority for assessment and nursing interventions. Handoff Report/Chart ReviewAdditional data cues that are helpful in guiding prioritization come from information obtained during a handoff nursing report and review of the patient chart. These data cues can be used to establish a patient’s baseline status and prioritize new clinical concerns based on abnormal assessment findings. Let’s consider Scenario G in the following box based on cues from a handoff report and how it might be used to help prioritize nursing care. Imagine you are receiving the following handoff report from the night shift nurse for a patient admitted to the medical-surgical unit with pneumonia: At the beginning of my shift, the patient was on room air with an oxygen saturation of 93%. She had slight crackles in both bases of her posterior lungs. At 0530, the patient rang the call light to go to the bathroom. As I escorted her to the bathroom, she appeared slightly short of breath. Upon returning the patient to bed, I rechecked her vital signs and found her oxygen saturation at 88% on room air and respiratory rate of 20. I listened to her lung sounds and noticed more persistent crackles and coarseness than at bedtime. I placed the patient on 2 L/minute of oxygen via nasal cannula. Within 5 minutes, her oxygen saturation increased to 92%, and she reported increased ease in respiration. Based on the handoff report, the night shift nurse provided substantial clinical evidence that the patient may be experiencing a change in condition. Although these changes could be attributed to lack of lung expansion that occurred while the patient was sleeping, there is enough information to indicate to the oncoming nurse that follow-up assessment and interventions should be prioritized for this patient because of potentially worsening respiratory status. In this manner, identifying data cues from a handoff report can assist with prioritization. Now imagine the night shift nurse had not reported this information during the handoff report. Is there another method for identifying potential changes in patient condition? Many nurses develop a habit of reviewing their patients’ charts at the start of every shift to identify trends and “baselines” in patient condition. For example, a chart review reveals a patient’s heart rate on admission was 105 beats per minute. If the patient continues to have a heart rate in the low 100s, the nurse is not likely to be concerned if today’s vital signs reveal a heart rate in the low 100s. Conversely, if a patient’s heart rate on admission was in the 60s and has remained in the 60s throughout their hospitalization, but it is now in the 100s, this finding is an important cue requiring prioritized assessment and intervention. Diagnostic InformationDiagnostic results are also important when prioritizing care. In fact, the National Patient Safety Goals from The Joint Commission include prompt reporting of important test results. New abnormal laboratory results are typically flagged in a patient’s chart or are reported directly by phone to the nurse by the laboratory as they become available. Newly reported abnormal results, such as elevated blood levels or changes on a chest X-ray, may indicate a patient’s change in condition and require additional interventions. For example, consider Scenario H in which you are the nurse providing care for five medical-surgical patients. You completed morning assessments on your assigned five patients. Patient A previously underwent a total right knee replacement and will be discharged home today. You are about to enter Patient A’s room to begin discharge teaching when you receive a phone call from the laboratory department, reporting a critical hemoglobin of 6.9 gm/dL on Patient B. Rather than enter Patient A’s room to perform discharge teaching, you immediately reprioritize your care. You call the primary provider to report Patient B’s critical hemoglobin level and determine if additional intervention, such as a blood transfusion, is required. 2.4. CRITICAL THINKING AND CLINICAL REASONINGPrioritization of patient care should be grounded in critical thinking rather than just a checklist of items to be done. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.”[ 1 ] Certainly, there are many actions that nurses must complete during their shift, but nursing requires adaptation and flexibility to meet emerging patient needs. It can be challenging for a novice nurse to change their mindset regarding their established “plan” for the day, but the sooner a nurse recognizes prioritization is dictated by their patients’ needs, the less frustration the nurse might experience. Prioritization strategies include collection of information and utilization of clinical reasoning to determine the best course of action. Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [2] When nurses use critical thinking and clinical reasoning skills, they set forth on a purposeful course of intervention to best meet patient-care needs. Rather than focusing on one’s own priorities, nurses utilizing critical thinking and reasoning skills recognize their actions must be responsive to their patients. For example, a nurse using critical thinking skills understands that scheduled morning medications for their patients may be late if one of the patients on their care team suddenly develops chest pain. Many actions may be added or removed from planned activities throughout the shift based on what is occurring holistically on the patient-care team. Additionally, in today’s complex health care environment, it is important for the novice nurse to recognize the realities of the current health care environment. Patients have become increasingly complex in their health care needs, and organizations are often challenged to meet these care needs with limited staffing resources. It can become easy to slip into the mindset of disenchantment with the nursing profession when first assuming the reality of patient-care assignments as a novice nurse. The workload of a nurse in practice often looks and feels quite different than that experienced as a nursing student. As a nursing student, there may have been time for lengthy conversations with patients and their family members, ample time to chart, and opportunities to offer personal cares, such as a massage or hair wash. Unfortunately, in the time-constrained realities of today’s health care environment, novice nurses should recognize that even though these “extra” tasks are not always possible, they can still provide quality, safe patient care using the “CURE” prioritization framework. Rather than feeling frustrated about “extras” that cannot be accomplished in time-constrained environments, it is vital to use prioritization strategies to ensure appropriate actions are taken to complete what must be done. With increased clinical experience, a novice nurse typically becomes more comfortable with prioritizing and reprioritizing care. Prioritization of patient care should be grounded in critical thinking rather than just a checklist of items to be done. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.”[ 1 ] Certainly, there are many actions that nurses must complete during their shift, but nursing requires adaptation and flexibility to meet emerging patient needs. It can be challenging for a novice nurse to change their mindset regarding their established “plan” for the day, but the sooner a nurse recognizes prioritization is dictated by their patients’ needs, the less frustration the nurse might experience. Prioritization strategies include collection of information and utilization of clinical reasoning to determine the best course of action. Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.”[ 2 ] 2.7. LEARNING ACTIVITIESLearning activities. (Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activities are provided as immediate feedback.)
The CURE hierarchy has been introduced to help novice nurses better understand how to manage competing patient needs. The CURE hierarchy uses the acronym “CURE” to help guide prioritization based on identifying the differences among C ritical needs, U rgent needs, R outine needs, and E xtras. You are the nurse caring for the patients in the following table. For each patient, indicate if this is a “critical,” “urgent,” “routine,” or “extra” need.
 II. GLOSSARYAirway, breathing, and circulation. Nursing problems currently occurring with the patient. The level of patient care that is required based on the severity of a patient’s illness or condition. A staffing model used to make patient assignments that reflects the individualized nursing care required for different types of patients. Conditions having a sudden onset. Conditions that have a slow onset and may gradually worsen over time. A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.”[ 1 ] A broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.”[ 2 ] A strategy for prioritization based on identifying “critical” needs, “urgent” needs, “routine” needs, and “extras.” Pieces of significant clinical information that direct the nurse toward a potential clinical concern or a change in condition. Conditions that are likely to occur or anticipated in the course of an illness, disease, or injury. Prioritization strategies often reflect the foundational elements of physiological needs and safety and progr ess toward higher levels. A staffing model used to make patient assignments in terms of one nurse caring for a set number of patients. A nursing problem that reflects that a patient may experience a problem but does not currently have signs reflecting the problem is actively occurring. A prioritization strategy including the review of planned tasks and allocation of time believed to be required to complete each task. A feeling of racing against a clock that is continually working against you. Conditions that are not likely to occur in the normal progression of an illness, disease, or injury. Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .
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Your browsing activity is empty. Activity recording is turned off. Turn recording back on Connect with NLM National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers  2.3 Tools for PrioritizingPrioritization of care for multiple clients while also performing daily nursing tasks can feel overwhelming in today’s fast-paced health care system. Because of the rapid and ever-changing conditions of clients and the structure of one’s workday, nurses must use organizational frameworks to prioritize actions and interventions. These frameworks can help ease anxiety, enhance personal organization and confidence, and ensure client safety. Acuity and intensity are foundational concepts for prioritizing nursing care and interventions. Acuity refers to the level of client care that is required based on the severity of a client’s illness or condition. For example, acuity may include characteristics such as unstable vital signs, oxygenation therapy, high-risk IV medications, multiple drainage devices, or uncontrolled pain. A “high-acuity” client requires several nursing interventions and frequent nursing assessments. Intensity addresses the time needed to complete nursing care and interventions such as providing assistance with activities of daily living (ADLs), performing wound care, or administering several medication passes. For example, a “high-intensity” client generally requires frequent or long periods of psychosocial, educational, or hygiene care from nursing staff members. High-intensity clients may also have increased needs for safety monitoring, familial support, or other needs. [1] Many health care organizations structure their staffing assignments based on acuity and intensity ratings to help provide equity in staff assignments. Acuity helps to ensure that nursing care is strategically divided among nursing staff. An equitable assignment of clients benefits both the nurse and client by helping to ensure that client care needs do not overwhelm individual staff and safe care is provided. Organizations use a variety of systems when determining client acuity with rating scales based on nursing care delivery, client stability, and care needs. See an example of a client acuity tool published in the American Nurse in Table 2.3. [2] In this example, ratings range from 1 to 4, with a rating of 1 indicating a relatively stable client requiring minimal individualized nursing care and intervention. A rating of 2 reflects a client with a moderate risk who may require more frequent intervention or assessment. A rating of 3 is attributed to a complex client who requires frequent intervention and assessment. This client might also be a new admission or someone who is confused and requires more direct observation. A rating of 4 reflects a high-risk client. For example, this individual may be experiencing frequent changes in vital signs, may require complex interventions such as the administration of blood transfusions, or may be experiencing significant uncontrolled pain. An individual with a rating of 4 requires more direct nursing care and intervention than a client with a rating of 1 or 2. [3] Table 2.3. Example of a Client Acuity Tool [4] Read more about using a client acuity tool on a medical-surgical unit. Rating scales may vary among institutions, but the principles of the rating system remain the same. Organizations include various client care elements when constructing their staffing plans for each unit. Read more information about staffing models and acuity in the following box. Staffing Models and Acuity Organizations that base staffing on acuity systems attempt to evenly staff client assignments according to their acuity ratings. This means that when comparing client assignments across nurses on a unit, similar acuity team scores should be seen with the goal of achieving equitable and safe division of workload across the nursing team. For example, one nurse should not have a total acuity score of 6 for their client assignments while another nurse has a score of 15. If this situation occurred, the variation in scoring reflects a discrepancy in workload balance and would likely be perceived by nursing peers as unfair. Using acuity-rating staffing models is helpful to reflect the individualized nursing care required by different clients. Alternatively, nurse staffing models may be determined by staffing ratio. Ratio-based staffing models are more straightforward in nature, where each nurse is assigned care for a set number of clients during their shift. Ratio-based staffing models may be useful for administrators creating budget requests based on the number of staff required for client care, but can lead to an inequitable division of work across the nursing team when client acuity is not considered. Increasingly complex clients require more time and interventions than others, so a blend of both ratio and acuity-based staffing is helpful when determining staffing assignments. [5] As a practicing nurse, you will be oriented to the elements of acuity ratings within your health care organization, but it is also important to understand how you can use these acuity ratings for your own prioritization and task delineation. Let’s consider the Scenario B in the following box to better understand how acuity ratings can be useful for prioritizing nursing care. You report to work at 6 a.m. for your nursing shift on a busy medical-surgical unit. Prior to receiving the handoff report from your night shift nursing colleagues, you review the unit staffing grid and see that you have been assigned to four clients to start your day. The clients have the following acuity ratings: Client A: 45-year-old client with paraplegia admitted for an infected sacral wound, with an acuity rating of 4. Client B: 87-year-old client with pneumonia with a low-grade fever of 99.7 F and receiving oxygen at 2 L/minute via nasal cannula, with an acuity rating of 2. Client C: 63-year-old client who is postoperative Day 1 from a right total hip replacement and is receiving pain management via a PCA pump, with an acuity rating of 2. Client D: 83-year-old client admitted with a UTI who is finishing an IV antibiotic cycle and will be discharged home today, with an acuity rating of 1. Based on the acuity rating system, your client assignment load receives an overall acuity score of 9. Consider how you might use their acuity ratings to help you prioritize your care. Based on what is known about the clients related to their acuity rating, whom might you identify as your care priority? Although this can feel like a challenging question to answer because of the many unknown elements in the situation using acuity numbers alone, Client A with an acuity rating of 4 would be identified as the care priority requiring assessment early in your shift. Although acuity can a useful tool for determining care priorities, it is important to recognize the limitations of this tool and consider how other client needs impact prioritization. Maslow’s Hierarchy of NeedsWhen thinking back to your first nursing or psychology course, you may recall a historical theory of human motivation based on various levels of human needs called Maslow’s Hierarchy of Needs. Maslow’s Hierarchy of Needs reflects foundational human needs with progressive steps moving towards higher levels of achievement. This hierarchy of needs is traditionally represented as a pyramid with the base of the pyramid serving as essential needs that must be addressed before one can progress to another area of need. [6] See Figure 2.1 [7] for an illustration of Maslow’s Hierarchy of Needs. Maslow’s Hierarchy of Needs places physiological needs as the foundational base of the pyramid. [8] Physiological needs include oxygen, food, water, sex, sleep, homeostasis, and excretion. The second level of Maslow’s hierarchy reflects safety needs. Safety needs include elements that keep individuals safe from harm. Examples of safety needs in health care include fall precautions. The third level of Maslow’s hierarchy reflects emotional needs such as love and a sense of belonging. These needs are often reflected in an individual’s relationships with family members and friends. The top two levels of Maslow’s hierarchy include esteem and self-actualization. An example of addressing these needs in a health care setting is helping an individual build self-confidence in performing blood glucose checks that leads to improved self-management of their diabetes. So how does Maslow’s theory impact prioritization? To better understand the application of Maslow’s theory to prioritization, consider Scenario C in the following box. You are an emergency response nurse working at a local shelter in a community that has suffered a devastating hurricane. Many individuals have relocated to the shelter for safety in the aftermath of the hurricane. Much of the community is still without electricity and clean water, and many homes have been destroyed. You approach a young woman who has a laceration on her scalp that is bleeding through her gauze dressing. The woman is weeping as she describes the loss of her home stating, “I have lost everything! I just don’t know what I am going to do now. It has been a day since I have had water or anything to drink. I don’t know where my sister is, and I can’t reach any of my family to find out if they are okay!” Despite this relatively brief interaction, this woman has shared with you a variety of needs. She has demonstrated a need for food, water, shelter, homeostasis, and family. As the nurse caring for her, it might be challenging to think about where to begin her care. These thoughts could be racing through your mind: Should I begin to make phone calls to try and find her family? Maybe then she would be able to calm down. Should I get her on the list for the homeless shelter so she wouldn’t have to worry about where she will sleep tonight? She hasn’t eaten in a while; I should probably find her something to eat. All these needs are important and should be addressed at some point, but Maslow’s hierarchy provides guidance on what needs must be addressed first. Use the foundational level of Maslow’s pyramid of physiological needs as the top priority for care. The woman is bleeding heavily from a head wound and has had limited fluid intake. As the nurse caring for this client, it is important to immediately intervene to stop the bleeding and restore fluid volume. Stabilizing the client by addressing her physiological needs is required before undertaking additional measures such as contacting her family. Imagine if instead you made phone calls to find the client’s family and didn’t address the bleeding or dehydration – you might return to a severely hypovolemic client who has deteriorated and may be near death. In this example, prioritizing emotional needs above physiological needs can lead to significant harm to the client. Although this is a relatively straightforward example, the principles behind the application of Maslow’s hierarchy are essential. Addressing physiological needs before progressing toward additional need categories concentrates efforts on the most vital elements to enhance client well-being. Maslow’s hierarchy provides the nurse with a helpful framework for identifying and prioritizing critical client care needs. Airway, breathing, and circulation, otherwise known by the mnemonic “ABCs,” are another foundational element to assist the nurse in prioritization. Like Maslow’s hierarchy, using the ABCs to guide decision-making concentrates on the most critical needs for preserving human life. If a client does not have a patent airway, is unable to breathe, or has inadequate circulation, very little of what else we do matters. The client’s ABCs are reflected in Maslow’s foundational level of physiological needs and direct critical nursing actions and timely interventions. Let’s consider Scenario D in the following box regarding prioritization using the ABCs and the physiological base of Maslow’s hierarchy. You are a nurse on a busy cardiac floor charting your morning assessments on a computer at the nurses’ station. Down the hall from where you are charting, two of your assigned clients are resting comfortably in Room 504 and Room 506. Suddenly, both call lights ring from the rooms, and you answer them via the intercom at the nurses’ station. Room 504 has an 87-year-old male who has been admitted with heart failure, weakness, and confusion. He has a bed alarm for safety and has been ringing his call bell for assistance appropriately throughout the shift. He requires assistance to get out of bed to use the bathroom. He received his morning medications, which included a diuretic about 30 minutes previously, and now reports significant urge to void and needs assistance to the bathroom. Room 506 has a 47-year-old woman who was hospitalized with new onset atrial fibrillation with rapid ventricular response. The client underwent a cardioversion procedure yesterday that resulted in successful conversion of her heart back into normal sinus rhythm. She is reporting via the intercom that her “heart feels like it is doing that fluttering thing again” and she is having chest pain with breathlessness. Based upon these two client scenarios, it might be difficult to determine whom you should see first. Both clients are demonstrating needs in the foundational physiological level of Maslow’s hierarchy and require assistance. To prioritize between these clients’ physiological needs, the nurse can apply the principles of the ABCs to determine intervention. The client in Room 506 reports both breathing and circulation issues, warning indicators that action is needed immediately. Although the client in Room 504 also has an urgent physiological elimination need, it does not overtake the critical one experienced by the client in Room 506. The nurse should immediately assess the client in Room 506 while also calling for assistance from a team member to assist the client in Room 504. Prioritizing what should be done and when it can be done can be a challenging task when several clients all have physiological needs. Recently, there has been professional acknowledgement of the cognitive challenge for novice nurses in differentiating physiological needs. To expand on the principles of prioritizing using the ABCs, the CURE hierarchy has been introduced to help novice nurses better understand how to manage competing client needs. The CURE hierarchy uses the acronym “CURE” to guide prioritization based on identifying the differences among Critical needs, Urgent needs, Routine needs, and Extras. [9] “Critical” client needs require immediate action. Examples of critical needs align with the ABCs and Maslow’s physiological needs, such as symptoms of respiratory distress, chest pain, and airway compromise. No matter the complexity of their shift, nurses can be assured that addressing clients’ critical needs is the correct prioritization of their time and energies. After critical client care needs have been addressed, nurses can then address “urgent” needs. Urgent needs are characterized as needs that cause client discomfort or place the client at a significant safety risk. [10] The third part of the CURE hierarchy reflects “routine” client needs. Routine client needs can also be characterized as “typical daily nursing care” because the majority of a standard nursing shift is spent addressing routine client needs. Examples of routine daily nursing care include actions such as administering medication and performing physical assessments. [11] Although a nurse’s typical shift in a hospital setting includes these routine client needs, they do not supersede critical or urgent client needs. The final component of the CURE hierarchy is known as “extras.” Extras refer to activities performed in the care setting to facilitate client comfort but are not essential. [12] Examples of extra activities include providing a massage for comfort or washing a client’s hair. If a nurse has sufficient time to perform extra activities, they contribute to a client’s feeling of satisfaction regarding their care, but these activities are not essential to achieve client outcomes. Let’s apply the CURE mnemonic to client care in the following box. If we return to Scenario D regarding clients in Room 504 and 506, we can see the client in Room 504 is having urgent needs. He is experiencing a physiological need to urgently use the restroom and may also have safety concerns if he does not receive assistance and attempts to get up on his own because of weakness. He is on a bed alarm, which reflects safety considerations related to his potential to get out of bed without assistance. Despite these urgent indicators, the client in Room 506 is experiencing a critical need and takes priority. Recall that critical needs require immediate nursing action to prevent client deterioration. The clientin Room 506 with a rapid, fluttering heartbeat and shortness of breath has a critical need because without prompt assessment and intervention, their condition could rapidly decline and become fatal. In addition to using the identified frameworks and tools to assist with priority setting, nurses must also look at their clients’ data cues to help them identify care priorities. Data cues are pieces of significant clinical information that direct the nurse toward a potential clinical concern or a change in condition. For example, have the client’s vital signs worsened over the last few hours? Is there a new laboratory result that is concerning? Data cues are used in conjunction with prioritization frameworks to help the nurse holistically understand the client’s current status and where nursing interventions should be directed. Common categories of data clues include acute versus chronic conditions, actual versus potential problems, unexpected versus expected conditions, information obtained from the review of a client’s chart, and diagnostic information. Acute Versus Chronic ConditionsA common data cue that nurses use to prioritize care is considering if a condition or symptom is acute or chronic. Acute conditions have a sudden and severe onset. These conditions occur due to a sudden illness or injury, and the body often has a significant response as it attempts to adapt. Chronic conditions have a slow onset and may gradually worsen over time. The difference between an acute versus a chronic condition relates to the body’s adaptation response. Individuals with chronic conditions often experience less symptom exacerbation because their body has had time to adjust to the illness or injury. Let’s consider an example of two clients admitted to the medical-surgical unit complaining of pain in Scenario E in the following box. As part of your client assignment on a medical-surgical unit, you are caring for two clients who both ring the call light and report pain at the start of the shift. Client A was recently admitted with acute appendicitis, and Client B was admitted for observation due to weakness. Not knowing any additional details about the clients’ conditions or current symptoms, which client would receive priority in your assessment? Based on using the data cue of acute versus chronic conditions, Client A with a diagnosis of acute appendicitis would receive top priority for assessment over a client with chronic pain due to osteoarthritis. Clients experiencing acute pain require immediate nursing assessment and intervention because it can indicate a change in condition. Acute pain also elicits physiological effects related to the stress response, such as elevated heart rate, blood pressure, and respiratory rate, and should be addressed quickly. Actual Versus Potential ProblemsNursing diagnoses and the nursing care plan have significant roles in directing prioritization when interpreting assessment data cues. Actual problems refer to a clinical problem that is actively occurring with the client. A risk problem indicates the client may potentially experience a problem but they do not have current signs or symptoms of the problem actively occurring. Consider an example of prioritizing actual and potential problems in Scenario F in the following box. A 74-year-old woman with a previous history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital for pneumonia. She has generalized weakness, a weak cough, and crackles in the bases of her lungs. She is receiving IV antibiotics, fluids, and oxygen therapy. The client can sit at the side of the bed and ambulate with the assistance of staff, although she requires significant encouragement to ambulate. Nursing diagnoses are established for this client as part of the care planning process. One nursing diagnosis for this client is Ineffective Airway Clearance . This nursing diagnosis is an actual problem because the client is currently exhibiting signs of poor airway clearance with an ineffective cough and crackles in the lungs. Nursing interventions related to this diagnosis include coughing and deep breathing, administering nebulizer treatment, and evaluating the effectiveness of oxygen therapy. The client also has the nursing diagnosis Risk for Skin Breakdown based on her weakness and lack of motivation to ambulate. Nursing interventions related to this diagnosis include repositioning every two hours and assisting with ambulation twice daily. The established nursing diagnoses provide cues for prioritizing care. For example, if the nurse enters the client’s room and discovers the client is experiencing increased shortness of breath, nursing interventions to improve the client’s respiratory status receive top priority before attempting to get the client to ambulate. Although there may be times when risk problems may supersede actual problems, looking to the “actual” nursing problems can provide clues to assist with prioritization. Unexpected Versus Expected ConditionsIn a similar manner to using acute versus chronic conditions as a cue for prioritization, it is also important to consider if a client’s signs and symptoms are “expected” or “unexpected” based on their overall condition. Unexpected conditions are findings that are not likely to occur in the normal progression of an illness, disease, or injury. Expected conditions are findings that are likely to occur or are anticipated in the course of an illness, disease, or injury. Unexpected findings often require immediate action by the nurse. Let’s apply this tool to the two clients previously discussed in Scenario E. As you recall, both Client A (with acute appendicitis) and Client B (with weakness and diagnosed with osteoarthritis) are reporting pain. Acute pain typically receives priority over chronic pain. But what if both clients are also reporting nausea and have an elevated temperature? Although these symptoms must be addressed in both clients, they are “expected” symptoms with acute appendicitis (and typically addressed in the treatment plan) but are “unexpected” for the client with osteoarthritis. Critical thinking alerts you to the unexpected nature of these symptoms in Client B, so they receive priority for assessment and nursing interventions. Handoff Report/Chart ReviewAdditional data cues that are helpful in guiding prioritization come from information obtained during a handoff nursing report and review of the client chart. These data cues can be used to establish a client’s baseline status and prioritize new clinical concerns based on abnormal assessment findings. Let’s consider Scenario G in the following box based on cues from a handoff report and how it might be used to help prioritize nursing care. Imagine you are receiving the following handoff report from the night shift nurse for a client admitted to the medical-surgical unit with pneumonia: At the beginning of my shift, the client was on room air with an oxygen saturation of 93%. She had slight crackles in both bases of her posterior lungs. At 0530, the client rang the call light to go to the bathroom. As I escorted her to the bathroom, she appeared slightly short of breath. Upon returning the client to bed, I rechecked her vital signs and found her oxygen saturation at 88% on room air and respiratory rate of 20. I listened to her lung sounds and noticed more persistent crackles and coarseness than at bedtime. I placed the client on 2 L/minute of oxygen via nasal cannula. Within five minutes, her oxygen saturation increased to 92%, and she reported increased ease in respiration. Based on the handoff report, the night shift nurse provided substantial clinical evidence that the client may be experiencing a change in condition. Although these changes could be attributed to lack of lung expansion that occurred while the client was sleeping, there is enough information to indicate to the oncoming nurse that follow-up assessment and interventions should be prioritized for this client because of potentially worsening respiratory status. In this manner, identifying data cues from a handoff report can assist with prioritization. Now imagine the night shift nurse had not reported this information during the handoff report. Is there another method for identifying potential changes in client condition? Many nurses develop a habit of reviewing their clients’ charts at the start of every shift to identify trends and “baselines” in client condition. For example, a chart review reveals a client’s heart rate on admission was 105 beats per minute. If the client continues to have a heart rate in the low 100s, the nurse is not likely to be concerned if today’s vital signs reveal a heart rate in the low 100s. Conversely, if a client’s heart rate on admission was in the 60s and has remained in the 60s throughout their hospitalization, but it is now in the 100s, this finding is an important cue requiring prioritized assessment and intervention. Diagnostic InformationDiagnostic results are also important when prioritizing care. In fact, the National Patient Safety Goals from The Joint Commission include prompt reporting of important test results. New abnormal laboratory results are typically flagged in a client’s chart or are reported directly by phone to the nurse by the laboratory as they become available. Newly reported abnormal results, such as elevated blood levels or changes on a chest X-ray, may indicate a client’s change in condition and require additional interventions. For example, consider Scenario H in which you are the nurse providing care for five medical-surgical clients. You completed morning assessments on your assigned five clients. Client A previously underwent a total right knee replacement and will be discharged home today. You are about to enter Client A’s room to begin discharge teaching when you receive a phone call from the laboratory department, reporting a critical hemoglobin of 6.9 gm/dL on Client B. Rather than enter Client A’s room to perform discharge teaching, you immediately reprioritize your care. You call the primary provider to report Client B’s critical hemoglobin level and determine if additional intervention, such as a blood transfusion, is required. Prioritization Principles & Staffing Considerations [13] With the complexity of different staffing variables in health care settings, it can be challenging to identify a method and solution that will offer a resolution to every challenge. The American Nurses Association has identified five critical principles that should be considered for nurse staffing. These principles are as follows:
The level of patient care that is required based on the severity of a patient’s illness or condition. A staffing model used to make patient assignments that reflects the individualized nursing care required for different types of patients. A staffing model used to make patient assignments in terms of one nurse caring for a set number of patients. Prioritization strategies often reflect the foundational elements of physiological needs and safety and progress toward higher levels. Airway, breathing, and circulation. Pieces of clinical information that direct the nurse toward a potential “actual problem” or a change in condition. Conditions having a sudden and severe onset. Have a slow onset and may gradually worsen over time. Nursing problems currently occurring with the patient. A nursing problem that reflects that a patient may experience a problem but does not currently have signs reflecting the problem is actively occurring. Conditions that are not likely to occur in the normal progression of an illness, disease or injury. Conditions that are likely to occur or anticipated in the course of an illness, disease, or injury. Nursing Management and Professional Concepts 2e Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.
MoSCoW PrioritizationWhat is moscow prioritization. MoSCoW prioritization, also known as the MoSCoW method or MoSCoW analysis, is a popular prioritization technique for managing requirements. The acronym MoSCoW represents four categories of initiatives: must-have, should-have, could-have, and won’t-have, or will not have right now. Some companies also use the “W” in MoSCoW to mean “wish.” What is the History of the MoSCoW Method?Software development expert Dai Clegg created the MoSCoW method while working at Oracle. He designed the framework to help his team prioritize tasks during development work on product releases. You can find a detailed account of using MoSCoW prioritization in the Dynamic System Development Method (DSDM) handbook . But because MoSCoW can prioritize tasks within any time-boxed project, teams have adapted the method for a broad range of uses. How Does MoSCoW Prioritization Work?Before running a MoSCoW analysis, a few things need to happen. First, key stakeholders and the product team need to get aligned on objectives and prioritization factors. Then, all participants must agree on which initiatives to prioritize. At this point, your team should also discuss how they will settle any disagreements in prioritization. If you can establish how to resolve disputes before they come up, you can help prevent those disagreements from holding up progress. Finally, you’ll also want to reach a consensus on what percentage of resources you’d like to allocate to each category. With the groundwork complete, you may begin determining which category is most appropriate for each initiative. But, first, let’s further break down each category in the MoSCoW method. Start prioritizing your roadmapMoscow prioritization categories.  1. Must-have initiativesAs the name suggests, this category consists of initiatives that are “musts” for your team. They represent non-negotiable needs for the project, product, or release in question. For example, if you’re releasing a healthcare application, a must-have initiative may be security functionalities that help maintain compliance. The “must-have” category requires the team to complete a mandatory task. If you’re unsure about whether something belongs in this category, ask yourself the following.  If the product won’t work without an initiative, or the release becomes useless without it, the initiative is most likely a “must-have.” 2. Should-have initiativesShould-have initiatives are just a step below must-haves. They are essential to the product, project, or release, but they are not vital. If left out, the product or project still functions. However, the initiatives may add significant value. “Should-have” initiatives are different from “must-have” initiatives in that they can get scheduled for a future release without impacting the current one. For example, performance improvements, minor bug fixes, or new functionality may be “should-have” initiatives. Without them, the product still works. 3. Could-have initiativesAnother way of describing “could-have” initiatives is nice-to-haves. “Could-have” initiatives are not necessary to the core function of the product. However, compared with “should-have” initiatives, they have a much smaller impact on the outcome if left out. So, initiatives placed in the “could-have” category are often the first to be deprioritized if a project in the “should-have” or “must-have” category ends up larger than expected. 4. Will not have (this time)One benefit of the MoSCoW method is that it places several initiatives in the “will-not-have” category. The category can manage expectations about what the team will not include in a specific release (or another timeframe you’re prioritizing). Placing initiatives in the “will-not-have” category is one way to help prevent scope creep . If initiatives are in this category, the team knows they are not a priority for this specific time frame. Some initiatives in the “will-not-have” group will be prioritized in the future, while others are not likely to happen. Some teams decide to differentiate between those by creating a subcategory within this group. How Can Development Teams Use MoSCoW?Although Dai Clegg developed the approach to help prioritize tasks around his team’s limited time, the MoSCoW method also works when a development team faces limitations other than time. For example: Prioritize based on budgetary constraints.What if a development team’s limiting factor is not a deadline but a tight budget imposed by the company? Working with the product managers, the team can use MoSCoW first to decide on the initiatives that represent must-haves and the should-haves. Then, using the development department’s budget as the guide, the team can figure out which items they can complete. Prioritize based on the team’s skillsets.A cross-functional product team might also find itself constrained by the experience and expertise of its developers. If the product roadmap calls for functionality the team does not have the skills to build, this limiting factor will play into scoring those items in their MoSCoW analysis. Prioritize based on competing needs at the company.Cross-functional teams can also find themselves constrained by other company priorities. The team wants to make progress on a new product release, but the executive staff has created tight deadlines for further releases in the same timeframe. In this case, the team can use MoSCoW to determine which aspects of their desired release represent must-haves and temporarily backlog everything else. What Are the Drawbacks of MoSCoW Prioritization?Although many product and development teams have prioritized MoSCoW, the approach has potential pitfalls. Here are a few examples. 1. An inconsistent scoring process can lead to tasks placed in the wrong categories.One common criticism against MoSCoW is that it does not include an objective methodology for ranking initiatives against each other. Your team will need to bring this methodology to your analysis. The MoSCoW approach works only to ensure that your team applies a consistent scoring system for all initiatives. Pro tip: One proven method is weighted scoring, where your team measures each initiative on your backlog against a standard set of cost and benefit criteria. You can use the weighted scoring approach in ProductPlan’s roadmap app . 2. Not including all relevant stakeholders can lead to items placed in the wrong categories.To know which of your team’s initiatives represent must-haves for your product and which are merely should-haves, you will need as much context as possible. For example, you might need someone from your sales team to let you know how important (or unimportant) prospective buyers view a proposed new feature. One pitfall of the MoSCoW method is that you could make poor decisions about where to slot each initiative unless your team receives input from all relevant stakeholders. 3. Team bias for (or against) initiatives can undermine MoSCoW’s effectiveness.Because MoSCoW does not include an objective scoring method, your team members can fall victim to their own opinions about certain initiatives. One risk of using MoSCoW prioritization is that a team can mistakenly think MoSCoW itself represents an objective way of measuring the items on their list. They discuss an initiative, agree that it is a “should have,” and move on to the next. But your team will also need an objective and consistent framework for ranking all initiatives. That is the only way to minimize your team’s biases in favor of items or against them. When Do You Use the MoSCoW Method for Prioritization?MoSCoW prioritization is effective for teams that want to include representatives from the whole organization in their process. You can capture a broader perspective by involving participants from various functional departments. Another reason you may want to use MoSCoW prioritization is it allows your team to determine how much effort goes into each category. Therefore, you can ensure you’re delivering a good variety of initiatives in each release. What Are Best Practices for Using MoSCoW Prioritization?If you’re considering giving MoSCoW prioritization a try, here are a few steps to keep in mind. Incorporating these into your process will help your team gain more value from the MoSCoW method. 1. Choose an objective ranking or scoring system.Remember, MoSCoW helps your team group items into the appropriate buckets—from must-have items down to your longer-term wish list. But MoSCoW itself doesn’t help you determine which item belongs in which category. You will need a separate ranking methodology. You can choose from many, such as:
For help finding the best scoring methodology for your team, check out ProductPlan’s article: 7 strategies to choose the best features for your product . 2. Seek input from all key stakeholders.To make sure you’re placing each initiative into the right bucket—must-have, should-have, could-have, or won’t-have—your team needs context. At the beginning of your MoSCoW method, your team should consider which stakeholders can provide valuable context and insights. Sales? Customer success? The executive staff? Product managers in another area of your business? Include them in your initiative scoring process if you think they can help you see opportunities or threats your team might miss. 3. Share your MoSCoW process across your organization.MoSCoW gives your team a tangible way to show your organization prioritizing initiatives for your products or projects. The method can help you build company-wide consensus for your work, or at least help you show stakeholders why you made the decisions you did. Communicating your team’s prioritization strategy also helps you set expectations across the business. When they see your methodology for choosing one initiative over another, stakeholders in other departments will understand that your team has thought through and weighed all decisions you’ve made. If any stakeholders have an issue with one of your decisions, they will understand that they can’t simply complain—they’ll need to present you with evidence to alter your course of action. Related Terms 2×2 prioritization matrix / Eisenhower matrix / DACI decision-making framework / ICE scoring model / RICE scoring model Prioritizing your roadmap using our guideTalk to an expert. Schedule a few minutes with us to share more about your product roadmapping goals and we'll tailor a demo to show you how easy it is to build strategic roadmaps, align behind customer needs, prioritize, and measure success. Share on Mastodon | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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NCLEX Critical Care Nurse Question. 4.3 (18 reviews) A client receiving a transfusion of packed red blood cells begins to vomit. The client's blood pressure is 90/50 mm Hg from a baseline of 125/78 mm Hg. The client's temperature is 100.8 ° F orally from a baseline of 99.2 ° F. The nurse determines that the client may be experiencing which ...
1.) 62 year-old man with COPD who has just completed his scheduled bronchodilator. 2.) 68 year-old woman with type 2 diabetes who had CVA 2 days ago. 3.) 72 year-old woman with history of asthma with HR 90 and is due for her beta-blocker. 4.) 48 year-old man admitted with cellulitis of his right hand after a construction accident, currently on ...
CCRN Practice Test. Take this free CCRN practice test to get a sample of the types of questions on the actual Critical Care Registered Nurse certification exam. The CCRN exam is a 3 hour exam covering 150 multiple choice questions. The CCRN exams focus on three general populations: adult, pediatric and neonatal patients.
94 Multiple choice questions. as part of nursing management of critically ill patient, orders are written to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from mech vent, and implement oral care protocol every 4 hours. These intervention are done as a group to reduce ...
Each question begins with a short scenario in which respondents are asked to make a decision as they might in a critical-care nursing role. The CCRN exam costs $250 for members of the American Association of Critical-Care Nurses and $365 for non-members. Additional information for each section of the test is provided; a comprehensive ...
CCU is probably one of the most difficult topics in Nursing. But with our Critical Care Nursing comprehensive quizzes and tests, you'll find it easy to learn. ... Critical Care NCLEX style questions ... 17. Decks. 668. Flashcards. 1,200. Learners. Professional Nursing - PNUR1157 - 22S - Sec 1.
Adult CCRN Practice Test. The Critical Care Nurses Certification (CCRN) is a certification granted by the American Association of Critical-Care Nurses (AACN). Answer the CCRN practice questions below to begin your studies! The CCRN certification shows that you have the special knowledge required for acute and critical care nursing.
Critical Care Nursing Final Exam. Free Practice Test Instructions: Choose your answer to the question and click "Continue" to see how you did. Then click 'Next Question' to answer the next ...
Exam Details: Total Questions: 150 (125 scored + 25 unscored pretest questions) Exam Duration: 3 hours. Format: Multiple-choice, computer-based test. Eligibility: Candidates must meet clinical practice requirements, typically having worked a certain number of hours in direct care of acutely/critically ill adult patients.
a. Monitor oxygen saturation every 4 hrs. b. Encourage coughing and deep breathing every 4 hrs. c. Elevate the head of bed. d. Asses respiratory rate and breath sounds every 4 hrs. 2) A client who is involved in a motor vehicle crash presents to the emergency department with severe internal bleeding.
Critical Care Final Exam and Quiz Questions. 106 terms. skylar-senseny. Preview. Critical Care Final . 67 terms. paigejordan8433. Preview. English Exam S1, 23' 6 terms. hteeter9. Preview. Teaching Interview Questions. ... Which nursing action takes priority? a. Moving the client as little as possible b.
Test your knowledge of critical care nursing with this quiz! Explore topics such as patient assessment, emergency interventions, and specialized care for critically ill patients. Challenge yourself with questions about intensive care unit (ICU) nursing and the unique skills required in this high-stakes field.
Study Critical Care using smart web & mobile flashcards created by top students, teachers, and professors. Prep for a quiz or learn for fun! ... Burn NCLEX style Questions, Burn Notes, Critical Care NCLEX style questions ... 17. Decks. 668. Flashcards. 1,200. Learners. ... Chapter 1 Overview of critical care nursing, Topic 2 Sedation, Topic 3 ...
Welcome to our ICU Related MCQ Quiz, specially crafted to challenge your knowledge and understanding of critical care concepts. This quiz is designed for healthcare professionals working in the intensive care unit (ICU), including nurses, physicians, and allied healthcare providers. In this quiz, you'll encounter a variety of multiple-choice questions covering a wide range of topics relevant ...
A critical care nurse is a nurse who works with patients with _____ medical problems. 1. Critical care nurses can improve their quality of care by _____. All answers are correct. 2. In order to ...
Based on AACN's Synergy Model for Patient Care, the exam assesses your ability to integrate your knowledge, skills, and abilities delivering acute/critically ill patient care. Consisting of 150 multiple-choice questions, examined subject matter covers clinical judgment (80%), and professional caring and ethical practice (20%).
introduction to critical care nursing quiz 1. What is critical care nursing? Click the card to flip 👆. -holistic care of patients experiencing life threatening conditions in a specialized intensive care unit. -requires a specific skill set. -professional organizations promote EBP --> includes certification. Click the card to flip 👆.
The health care system faces a significant challenge in balancing the ever-expanding task of meeting patient care needs with scarce nursing resources that has even worsened as a result of the COVID-19 pandemic. With a limited supply of registered nurses, nurse managers are often challenged to implement creative staffing practices such as sending staff to units where they do not normally work ...
2.3 Tools for Prioritizing. Prioritization of care for multiple clients while also performing daily nursing tasks can feel overwhelming in today's fast-paced health care system. Because of the rapid and ever-changing conditions of clients and the structure of one's workday, nurses must use organizational frameworks to prioritize actions and ...
a) The flow rate is too low. b) The flow rate is too high. c) The client shouldn't receive oxygen. d) The flow rate is correct. b) The flow rate is too high. The administration of oxygen at 1 to 2 L/ minute by way of a nasal cannula is recommended for clients with COPD: therefore, a rate of 4 L/minute is too high.
MoSCoW prioritization, also known as the MoSCoW method or MoSCoW analysis, is a popular prioritization technique for managing requirements. The acronym MoSCoW represents four categories of initiatives: must-have, should-have, could-have, and won't-have, or will not have right now. Some companies also use the "W" in MoSCoW to mean "wish.".
A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer. B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D.
Answer: D) "Public health informatics is the use of information and information technology to improve public health practice and outcomes". A) Standardization of nursing care plans. B) Prevention of sequelae of the disease. C) Prevention of disease. D) Generation of new treatments.